1265929335 NPI number — BARRETT ENTERPRISE

Table of content: (NPI 1265929335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265929335 NPI number — BARRETT ENTERPRISE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRETT ENTERPRISE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265929335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 CROMPTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63126-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-584-9754
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 WOODLAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-7646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-206-2650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETT
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
636-206-2650

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609059468 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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