Provider Demographics
NPI:1386290187
Name:BYERLY, STEPHANIE KAYE
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KAYE
Last Name:BYERLY
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 262
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47145-0262
Mailing Address - Country:US
Mailing Address - Phone:812-572-5687
Mailing Address - Fax:
Practice Address - Street 1:523 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLISH
Practice Address - State:IN
Practice Address - Zip Code:47118-3699
Practice Address - Country:US
Practice Address - Phone:812-338-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker