MEDICARE: MRS. MARY D. BYRD LMHP, PC, LIMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	1258	NE
2	101Y00000X	Counselor	819	NE
3	101YM0800X	Mental Health Counselor	1180	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578663175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY D. BYRD LMHP, PC, LIMHP

Provider Business Mailing Address
First Line	:	16023 LINDENWOOD CIR
Second Line	:
City	:	BENNINGTON
State	:	NE
Zip	:	68007-7443
Country	:	US
Telephone Number	:	402-651-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 N 144TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4715
Country	:	US
Telephone Number	:	402-651-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	12/12/2016

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