Provider Demographics
NPI:1184831794
Name:BYROM, SALLY M
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:M
Last Name:BYROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 SPICEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3343
Mailing Address - Country:US
Mailing Address - Phone:512-258-7647
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE 160
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:832-632-5088
Practice Address - Fax:832-632-5089
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63448101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health