Provider Demographics
NPI:1104941350
Name:BYRD, MARY A
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:200 EAST CALHOUN STREET
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-1391
Mailing Address - Country:US
Mailing Address - Phone:662-983-4890
Mailing Address - Fax:
Practice Address - Street 1:333 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2322
Practice Address - Country:US
Practice Address - Phone:662-456-7011
Practice Address - Fax:662-456-7235
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health