Provider Demographics
NPI:1508336827
Name:BYRNE, CHASITY DAISEY (RAC)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:DAISEY
Last Name:BYRNE
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-3022
Mailing Address - Country:US
Mailing Address - Phone:318-253-8705
Mailing Address - Fax:318-253-7506
Practice Address - Street 1:118 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-3022
Practice Address - Country:US
Practice Address - Phone:318-253-8705
Practice Address - Fax:318-253-7506
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)