Provider Demographics
NPI:1548142185
Name:PACK, BYRON T (PSYD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:T
Last Name:PACK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 MERCHANTS ROW BLVD UNIT 1
Mailing Address - Street 2:1898 MERCHANTS ROW BLVD UNIT 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-4731
Mailing Address - Country:US
Mailing Address - Phone:850-566-7365
Mailing Address - Fax:
Practice Address - Street 1:1898 MERCHANTS ROW BLVD UNIT 1
Practice Address - Street 2:1898 MERCHANTS ROW BLVD UNIT 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-4731
Practice Address - Country:US
Practice Address - Phone:850-566-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical