Provider Demographics
NPI:1194249839
Name:BYRNE, REY REMUS
Entity type:Individual
Prefix:
First Name:REY
Middle Name:REMUS
Last Name:BYRNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7711 BONHOMME AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1964
Mailing Address - Country:US
Mailing Address - Phone:314-455-6799
Mailing Address - Fax:844-909-4744
Practice Address - Street 1:7711 BONHOMME AVE STE 850
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1964
Practice Address - Country:US
Practice Address - Phone:314-455-6799
Practice Address - Fax:844-909-4744
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127417106H00000X
390200000X
MO2021043650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program