Provider Demographics
NPI:1144436304
Name:WEBSTER, BYRON H (MS)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:H
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MS
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 364
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-0364
Mailing Address - Country:US
Mailing Address - Phone:208-356-0480
Mailing Address - Fax:
Practice Address - Street 1:5390 S. 3600 EAST
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-0364
Practice Address - Country:US
Practice Address - Phone:208-356-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-2693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist