Provider Demographics
NPI:1699913186
Name:BYRER, CLARK GREGORY (LCPC)
Entity type:Individual
Prefix:MR
First Name:CLARK
Middle Name:GREGORY
Last Name:BYRER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:CLARK
Other - Middle Name:GREGORY
Other - Last Name:BYRER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:178 MIDDLE STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-772-7532
Mailing Address - Fax:207-772-2670
Practice Address - Street 1:178 MIDDLE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-772-7532
Practice Address - Fax:207-772-2670
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional