Provider Demographics
NPI:1295979037
Name:BYRNE, RHONDA S (LMSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:BYRNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1976
Mailing Address - Country:US
Mailing Address - Phone:231-726-4735
Mailing Address - Fax:231-722-0789
Practice Address - Street 1:1195 E WILCOX AVE
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8673
Practice Address - Country:US
Practice Address - Phone:231-689-6701
Practice Address - Fax:231-689-6702
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063950101YM0800X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910524OtherBCBS
MI750910532OtherBCBS
MI750910517OtherBCBS
MI750910530OtherBCBS
MI1912452Medicaid
MI20351Medicare UPIN
MI750910513Medicare UPIN
MI750910527Medicare UPIN
MI20366Medicare UPIN
MI750910517OtherBCBS
MI20378Medicare UPIN
MI1912452Medicaid
MIOP22320Medicare PIN