Doctor Name: | MATTHEW TY BARRUS |
NPI Number: | 1003100181 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCSW-582 |
Business Practice Address: | 1106 Julie Ln Powell, WY - 824351632 |
Business Phone Number: | 3072717460 |
Business Fax Number: | |
Mailing Address: | 862 Risen Son Rd, POWELL |
State: | WY |
Postal Code: | 824358473 |
Phone Number: | 3072540575 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2011 |
NPI Last Update Date: | 06/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW-582 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |