Provider Demographics
NPI:1952449613
Name:BYERGO, TAMARA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:S
Last Name:BYERGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:5103 SW SURF SCOOTER ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4599
Mailing Address - Country:US
Mailing Address - Phone:816-537-9385
Mailing Address - Fax:
Practice Address - Street 1:5103 SW SURF SCOOTER ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4599
Practice Address - Country:US
Practice Address - Phone:816-537-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000168344103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist