MEDICARE: SUSAN R BYRD MA,LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	15139	TX

General Provider Information

NPI Number	:	1578621488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R BYRD MA,LPC

Provider Business Mailing Address
First Line	:	14902 PRESTON RD STE 404 # 302
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-9105
Country	:	US
Telephone Number	:	214-796-6177
Fax Number	:	972-774-0544

Provider Business Practice Location Address
First Line	:	14114 DALLAS PKWY STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-1316
Country	:	US
Telephone Number	:	972-774-0221
Fax Number	:	972-774-0544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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