=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003332065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELIE BYERLY MA, LPC, LMHC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2017
-----------------------------------------------------
Last Update Date | 08/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11141 COUNTY LINE RD UNIT 114
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-328-6034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14329 BARRACUDA RUN
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-0525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-205-0682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 15242
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------