Healthcare Provider Details

I. General information

NPI: 1023438892
Provider Name (Legal Business Name): ANDREA BARBOUR LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 86TH ST SUITE 210B
INDIANAPOLIS IN
46240-1859
US

IV. Provider business mailing address

921 E 86TH ST SUITE 210B
INDIANAPOLIS IN
46240-1859
US

V. Phone/Fax

Practice location:
  • Phone: 812-764-4931
  • Fax: 317-875-1060
Mailing address:
  • Phone: 812-764-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35001920A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001920A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number35001920A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: