Healthcare Provider Details

I. General information

NPI: 1558832535
Provider Name (Legal Business Name): ERIC BARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID ERIC BARR

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 S DECATUR BLVD STE C1
LAS VEGAS NV
89103-5863
US

IV. Provider business mailing address

4170 S DECATUR BLVD STE C1
LAS VEGAS NV
89103-5863
US

V. Phone/Fax

Practice location:
  • Phone: 702-659-8827
  • Fax:
Mailing address:
  • Phone: 702-659-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI2986
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: