Healthcare Provider Details

I. General information

NPI: 1760154652
Provider Name (Legal Business Name): MR. MAURICE ANTHONY BYERS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 GOUCHER BLVD STE A
TOWSON MD
21286-5677
US

IV. Provider business mailing address

PO BOX 39523
BALTIMORE MD
21212-6523
US

V. Phone/Fax

Practice location:
  • Phone: 443-652-4372
  • Fax:
Mailing address:
  • Phone: 443-652-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: