Healthcare Provider Details

I. General information

NPI: 1114334018
Provider Name (Legal Business Name): MS. MICHELLE BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 OLD MINDEN RD # 1113B
BOSSIER CITY LA
71112-2476
US

IV. Provider business mailing address

3018 OLD MINDEN RD # 1113B
BOSSIER CITY LA
71112-2476
US

V. Phone/Fax

Practice location:
  • Phone: 318-347-7662
  • Fax:
Mailing address:
  • Phone: 318-347-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4314
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1448
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: