Doctor Name: | MRS. KELLY NICOLE BARROW |
NPI Number: | 1699013300 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2013002402 |
Business Practice Address: | 4599 Jlj Ranch Rd De Soto, MO - 630203284 |
Business Phone Number: | 6362327723 |
Business Fax Number: | |
Mailing Address: | 3405 Brouks Ct, ARNOLD |
State: | MO |
Postal Code: | 630106520 |
Phone Number: | 3142265194 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2013 |
NPI Last Update Date: | 01/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2013002402 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |