Provider Demographics
NPI:1366703365
Name:THE BYRD GROUP LLC
Entity type:Organization
Organization Name:THE BYRD GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:702-265-3794
Mailing Address - Street 1:7734 VILLA DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1668
Mailing Address - Country:US
Mailing Address - Phone:702-265-3794
Mailing Address - Fax:702-363-2278
Practice Address - Street 1:7734 VILLA DEL MAR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1668
Practice Address - Country:US
Practice Address - Phone:702-265-3794
Practice Address - Fax:702-363-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty