Healthcare Provider Details

I. General information

NPI: 1902887144
Provider Name (Legal Business Name): CONSTANCE SUSAN BYERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OVERTON RIDGE BLVD SUITE 212
FORT WORTH TX
76132-1940
US

IV. Provider business mailing address

4900 OVERTON RIDGE BLVD SUITE 212
FORT WORTH TX
76132-1940
US

V. Phone/Fax

Practice location:
  • Phone: 817-370-2926
  • Fax: 817-370-2926
Mailing address:
  • Phone: 817-370-2926
  • Fax: 817-370-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: