Healthcare Provider Details

I. General information

NPI: 1407948540
Provider Name (Legal Business Name): EMILY CAROL BARR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

1849 PHILADELPHIA AVE SE
GRAND RAPIDS MI
49507-2868
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax: 989-831-7578
Mailing address:
  • Phone: 616-475-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: