Healthcare Provider Details

I. General information

NPI: 1336499219
Provider Name (Legal Business Name): ANGELA BARKER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S MCARTHUR ST
MACOMB IL
61455-2983
US

IV. Provider business mailing address

233 S MCARTHUR ST
MACOMB IL
61455-2983
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-2255
  • Fax: 309-833-2251
Mailing address:
  • Phone: 309-833-2255
  • Fax: 309-833-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180009582
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number178.008389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: