Healthcare Provider Details

I. General information

NPI: 1033125331
Provider Name (Legal Business Name): KEVIN DAVID BARROW LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 S SAN CARLA
GREEN VALLEY AZ
85614-1534
US

IV. Provider business mailing address

1412 S SAN CARLA
GREEN VALLEY AZ
85614-1534
US

V. Phone/Fax

Practice location:
  • Phone: 127-570-0395
  • Fax:
Mailing address:
  • Phone: 127-570-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14429
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: