Healthcare Provider Details

I. General information

NPI: 1295699098
Provider Name (Legal Business Name): BOBBIE L. BYRD CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 OLD DARBONNE RD
WEST MONROE LA
71291-4816
US

IV. Provider business mailing address

115 OAKLAND ST
WEST MONROE LA
71291-2813
US

V. Phone/Fax

Practice location:
  • Phone: 318-503-7061
  • Fax:
Mailing address:
  • Phone: 318-503-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT-6057
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: