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General NPI Number Information
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NPI Number | 1407985765
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Entity Type | Individual
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Provider Name | LARRY DONNELL BYRD JOB DEVELOPER
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 2864 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92104-2930
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Country | US
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Telephone | 619-683-7423
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Fax | 619-683-7428
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Provider Business Mailing Address
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Address Line | 1671 PENTECOST WAY UNIT 1
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City | SAN DIEGO
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State | CA
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Zip | 92105-5774
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Country | US
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Telephone | 619-352-6059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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