Individual
MR. MALCOLM BASIL BYRD II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CHES
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
(502) 772-8189
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 953-4700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255631
KY
Other
Enumeration date
07/27/2021
Last updated
04/27/2022
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