Provider Demographics
NPI:1801289632
Name:BRENDA BYRNE COUNSELING, L.L.P.
Entity type:Organization
Organization Name:BRENDA BYRNE COUNSELING, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-501-1785
Mailing Address - Street 1:2616 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-5734
Mailing Address - Country:US
Mailing Address - Phone:815-501-1785
Mailing Address - Fax:
Practice Address - Street 1:2616 19TH AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-5734
Practice Address - Country:US
Practice Address - Phone:815-501-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007787251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health