Healthcare Provider Details

I. General information

NPI: 1821763715
Provider Name (Legal Business Name): JARED MARSHALL BARROW PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST BLDG 122
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

4101 S 4TH ST BLDG 122
LEAVENWORTH KS
66048-5014
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 913-682-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS01983
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01983
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: