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General NPI Number Information
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NPI Number | 1245776269
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Entity Type | Organization
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Legal Business Name | TBYRD THERAPY SERVICES
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 131 BRECKENRIDGE LN
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City | MAUMELLE
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State | AR
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Zip | 72113-5935
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Country | US
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Telephone | 256-348-2811
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 CANTRELL RD STE 106
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City | LITTLE ROCK
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State | AR
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Zip | 72202-2016
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Country | US
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Telephone | 256-348-2811
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | TARANIIO A BYRD
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Credential | LCSW
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Telephone | 256-348-2811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6615-C
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License Number State | AR
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