Basic Information
Provider Information
NPI: 1417261462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYRD
FirstName: MEGHAN
MiddleName: JO
NamePrefix:  
NameSuffix:  
Credential: MHPP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 S. 48TH STREET
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 72762
CountryCode: US
TelephoneNumber: 4797502020
FaxNumber: 4797508967
Practice Location
Address1: 60 W SUNBRIDGE DR
Address2:  
City: FAYETTEVILLE
State: AR
PostalCode: 727031822
CountryCode: US
TelephoneNumber: 4797502020
FaxNumber: 4797508967
Other Information
ProviderEnumerationDate: 08/02/2010
LastUpdateDate: 07/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X ARY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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