Healthcare Provider Details

I. General information

NPI: 1821496647
Provider Name (Legal Business Name): MARTI BARICEVIC LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W MAIN ST
BELLEVILLE IL
62220-1501
US

IV. Provider business mailing address

107 W MAIN ST
BELLEVILLE IL
62220-1501
US

V. Phone/Fax

Practice location:
  • Phone: 618-978-2812
  • Fax:
Mailing address:
  • Phone: 618-978-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number178.007573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: