Healthcare Provider Details

I. General information

NPI: 1720324908
Provider Name (Legal Business Name): MICHELLE RENAE BYRD PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD SUITE 250
PLYMOUTH MI
48170-1497
US

IV. Provider business mailing address

409 PLYMOUTH RD SUITE 250
PLYMOUTH MI
48170-1497
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-9098
  • Fax:
Mailing address:
  • Phone: 734-416-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: