Provider Demographics
NPI:1588162507
Name:BYRD, COMILLER
Entity type:Individual
Prefix:
First Name:COMILLER
Middle Name:
Last Name:BYRD
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 1:25420 104TH AVE SE #1056
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6435
Mailing Address - Country:US
Mailing Address - Phone:206-504-1444
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:4238 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1311
Practice Address - Country:US
Practice Address - Phone:253-876-7600
Practice Address - Fax:253-876-7610
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist