Individual
NICOLE BYRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.MFT
Contact information
Practice address
100 SAW MILL RD, LAFAYETTE, IN 47905-5592
(765) 742-4848
(765) 477-9905
Mailing address
300 TIMBER TRAIL DR, APT. 308, LAFAYETTE, IN 47905-4666
(325) 280-7142
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100445230A
—
IN
Enumeration date
03/27/2007
Last updated
07/09/2007
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