Healthcare Provider Details

I. General information

NPI: 1104579614
Provider Name (Legal Business Name): LORETTA J MORRIS BARR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 W MARKET ST
LIMA OH
45805-2729
US

IV. Provider business mailing address

12992 MONROE MILLS RD
MOUNT VERNON OH
43050-9227
US

V. Phone/Fax

Practice location:
  • Phone: 740-501-1222
  • Fax:
Mailing address:
  • Phone: 740-501-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberCDCA.179653
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: