Healthcare Provider Details

I. General information

NPI: 1801854237
Provider Name (Legal Business Name): PAUL BRUCE BYRD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 S SCENIC BLVD
SPOKANE WA
99224-4704
US

IV. Provider business mailing address

2315 S SCENIC BLVD
SPOKANE WA
99224-4704
US

V. Phone/Fax

Practice location:
  • Phone: 509-570-6575
  • Fax:
Mailing address:
  • Phone: 509-570-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number308375-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: