Provider Demographics
NPI:1306961370
Name:BYRUM, LINDA IRENE (MA, LPC, LSOTP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:IRENE
Last Name:BYRUM
Suffix:
Gender:F
Credentials:MA, LPC, LSOTP
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 544
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-0544
Mailing Address - Country:US
Mailing Address - Phone:361-318-3185
Mailing Address - Fax:361-776-0911
Practice Address - Street 1:2051 W WHEELER AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4762
Practice Address - Country:US
Practice Address - Phone:361-318-3185
Practice Address - Fax:361-776-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB0077887Medicare UPIN