Healthcare Provider Details

I. General information

NPI: 1427804210
Provider Name (Legal Business Name): TREY ANDREW BYARS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SW G ST
GRANTS PASS OR
97526-2544
US

IV. Provider business mailing address

205 FRUITDALE DR
GRANTS PASS OR
97527-5267
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-2373
  • Fax:
Mailing address:
  • Phone: 541-479-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: