Provider Demographics
NPI:1962934323
Name:BYERS, MARY SUSAN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:BYERS
Suffix:
Gender:F
Credentials:LPC
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 467
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76366-0467
Mailing Address - Country:US
Mailing Address - Phone:940-631-1533
Mailing Address - Fax:
Practice Address - Street 1:3115A BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1818
Practice Address - Country:US
Practice Address - Phone:940-631-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional