Healthcare Provider Details

I. General information

NPI: 1154904969
Provider Name (Legal Business Name): TIMEYSHA BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HUDSON LN STE 202
MONROE LA
71201-6032
US

IV. Provider business mailing address

1401 HUDSON LN
MONROE LA
71201-6068
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-5700
  • Fax:
Mailing address:
  • Phone: 318-651-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: