Provider Demographics
NPI:1801077920
Name:BYRUM, CARLA L (LMSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:BYRUM
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 1:304 MONROE
Mailing Address - Street 2:
Mailing Address - City:LEWIS
Mailing Address - State:KS
Mailing Address - Zip Code:67552
Mailing Address - Country:US
Mailing Address - Phone:620-324-5499
Mailing Address - Fax:
Practice Address - Street 1:304 MONROE
Practice Address - Street 2:
Practice Address - City:LEWIS
Practice Address - State:KS
Practice Address - Zip Code:67552
Practice Address - Country:US
Practice Address - Phone:620-324-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker