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General NPI Number Information
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NPI Number | 1801289632
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Entity Type | Organization
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Legal Business Name | BRENDA BYRNE COUNSELING, L.L.P.
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 2616 19TH AVE
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City | ROCKFORD
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State | IL
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Zip | 61108-5734
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Country | US
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Telephone | 815-501-1785
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 19TH AVE
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City | ROCKFORD
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State | IL
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Zip | 61108-5734
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Country | US
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Telephone | 815-501-1785
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | BRENDA BYRNE
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Credential | LCPC
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Telephone | 815-501-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.007787
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License Number State | IL
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