Healthcare Provider Details

I. General information

NPI: 1861617219
Provider Name (Legal Business Name): BARBARA ROSE BERKSHIRE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 FREDERICA ST SUITE1003
OWENSBORO KY
42301-3050
US

IV. Provider business mailing address

PO BOX 1230
EVANSVILLE IN
47706-1230
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-8984
  • Fax: 270-689-0054
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0429
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: