Provider Demographics
NPI:1447392188
Name:BYSOM, TERRY (PHD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BYSOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260598
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0598
Mailing Address - Country:US
Mailing Address - Phone:214-577-8191
Mailing Address - Fax:
Practice Address - Street 1:1721 W PLANO PKWY
Practice Address - Street 2:#107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8634
Practice Address - Country:US
Practice Address - Phone:214-577-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17308101YP2500X
TX4968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional