Healthcare Provider Details

I. General information

NPI: 1861827420
Provider Name (Legal Business Name): JOSHUA LEE BARRY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ARNOLD DR STE 404
LITTLE ROCK AIR FORCE BASE AR
72099-4927
US

IV. Provider business mailing address

940 ARNOLD DR STE 404
LITTLE ROCK AIR FORCE BASE AR
72099-4927
US

V. Phone/Fax

Practice location:
  • Phone: 405-517-3723
  • Fax:
Mailing address:
  • Phone: 405-517-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0102266
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: