Provider Demographics
NPI:1205583226
Name:BYERS, CAROL JOAN
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JOAN
Last Name:BYERS
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 1:955 TARRAGON LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-6510
Mailing Address - Country:US
Mailing Address - Phone:513-259-6814
Mailing Address - Fax:513-575-1017
Practice Address - Street 1:7545 BEECHMONT AVE STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4238
Practice Address - Country:US
Practice Address - Phone:513-624-9100
Practice Address - Fax:513-624-7840
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI15000845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty