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General NPI Number Information
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NPI Number | 1033480389
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Entity Type | Organization
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Legal Business Name | SALLYBYROM PLLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 8500 N MOPAC EXPY STE 501
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City | AUSTIN
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State | TX
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Zip | 78759-8347
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Country | US
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Telephone | 512-695-8979
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 N MOPAC EXPY STE 501
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City | AUSTIN
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State | TX
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Zip | 78759-8347
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Country | US
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Telephone | 512-695-8979
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SALLY MILLER BYROM
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Credential | LPC, LMFT-ASSOCIATE
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Telephone | 512-695-8979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201245
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63448
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License Number State | TX
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