Healthcare Provider Details

I. General information

NPI: 1063133353
Provider Name (Legal Business Name): SYDNEY BYRD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11358 VAN CLEVE AVE
SAINT LOUIS MO
63114-1131
US

IV. Provider business mailing address

11453 PINEVIEW CROSSING DR
MARYLAND HEIGHTS MO
63043-5103
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-2350
  • Fax:
Mailing address:
  • Phone: 314-580-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022034551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: