Doctor Name: | MS. LISA DIANE BARKSTALL |
NPI Number: | 1003011321 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149.005051 |
Business Practice Address: | 1801 Fox Dr Champaign, IL - 618207236 |
Business Phone Number: | 2173988080 |
Business Fax Number: | |
Mailing Address: | 704 Arlington Ct, CHAMPAIGN |
State: | IL |
Postal Code: | 618205002 |
Phone Number: | 7737033583 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 04/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.005051 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |