Healthcare Provider Details

I. General information

NPI: 1326906363
Provider Name (Legal Business Name): KIANNA KAYLIN BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 MORTON ST
OAK PARK MI
48237-1675
US

IV. Provider business mailing address

24330 MORTON ST
OAK PARK MI
48237-1675
US

V. Phone/Fax

Practice location:
  • Phone: 248-342-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: