Healthcare Provider Details

I. General information

NPI: 1588162507
Provider Name (Legal Business Name): COMILLER BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 09/29/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

25420 104TH AVE SE #1056
KENT WA
98030-6435
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-7600
  • Fax: 253-876-7610
Mailing address:
  • Phone: 206-504-1444
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: