Healthcare Provider Details

I. General information

NPI: 1194897140
Provider Name (Legal Business Name): BARBARA BOSS MARTIN LPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 CLINTON BLVD
JACKSON MS
39209
US

IV. Provider business mailing address

120 KEITH LANE
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-923-1635
  • Fax: 601-923-1634
Mailing address:
  • Phone: 601-924-2041
  • Fax: 601-923-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0618
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0192
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: