Provider Demographics
NPI:1407985765
Name:BYRD, LARRY DONNELL (JOB DEVELOPER)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DONNELL
Last Name:BYRD
Suffix:
Gender:M
Credentials:JOB DEVELOPER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 PENTECOST WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5774
Mailing Address - Country:US
Mailing Address - Phone:619-352-6059
Mailing Address - Fax:
Practice Address - Street 1:2864 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2930
Practice Address - Country:US
Practice Address - Phone:619-683-7423
Practice Address - Fax:619-683-7428
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health