Provider Demographics
NPI:1124124532
Name:BYRNES, THOMAS F (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:BYRNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 N PROSPECT AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-224-0492
Mailing Address - Fax:414-224-8112
Practice Address - Street 1:2266 N PROSPECT AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202
Practice Address - Country:US
Practice Address - Phone:414-224-0492
Practice Address - Fax:414-224-8112
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI986125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39756900Medicaid