Provider Demographics
NPI:1932269834
Name:BYRD, CRYSTAL BETH (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:BETH
Last Name:BYRD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:408 EAST BLACKJACK
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-1254
Mailing Address - Country:US
Mailing Address - Phone:918-577-1448
Mailing Address - Fax:
Practice Address - Street 1:1700 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3340
Practice Address - Country:US
Practice Address - Phone:918-681-4201
Practice Address - Fax:918-681-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist