Provider Demographics
NPI:1992323851
Name:BYRD, REBECCA ANN (COUNSELOR)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BYRD
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MAPLE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1667
Mailing Address - Country:US
Mailing Address - Phone:502-468-6414
Mailing Address - Fax:
Practice Address - Street 1:455 PARK PL STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1881
Practice Address - Country:US
Practice Address - Phone:859-276-0533
Practice Address - Fax:859-277-3653
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172690101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)