Provider Demographics
NPI:1902887144
Name:BYERS, CONSTANCE SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SUSAN
Last Name:BYERS
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 1:4900 OVERTON RIDGE BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1940
Mailing Address - Country:US
Mailing Address - Phone:817-370-2926
Mailing Address - Fax:817-370-2926
Practice Address - Street 1:4900 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1940
Practice Address - Country:US
Practice Address - Phone:817-370-2926
Practice Address - Fax:817-370-2926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0T55LMedicare ID - Type UnspecifiedPSYCHOLOGIST