Provider Demographics
NPI:1023249166
Name:BYRD, ALICIA (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BYRD
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 1:2000 CARSON ST
Mailing Address - Street 2:G
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76117-5711
Mailing Address - Country:US
Mailing Address - Phone:817-228-3608
Mailing Address - Fax:817-626-8621
Practice Address - Street 1:2000 CARSON ST
Practice Address - Street 2:G
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76117-5711
Practice Address - Country:US
Practice Address - Phone:817-228-3608
Practice Address - Fax:817-626-8621
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional