Healthcare Provider Details

I. General information

NPI: 1699765560
Provider Name (Legal Business Name): MR. TERENCE MICHAEL BYRNES
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER MCHE-QD
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

8511 MEAGHAN MIST
HELOTES TX
78023-4703
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2460
  • Fax:
Mailing address:
  • Phone: 210-695-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10900
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: