Provider Demographics
NPI:1952765422
Name:BYRD, TAMI LYNN (LCDC, LPC)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNN
Last Name:BYRD
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:LYNN
Other - Last Name:DORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC, LPC
Mailing Address - Street 1:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-1641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:STE. 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:940-745-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12812101YA0400X
TX73108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)