Healthcare Provider Details

I. General information

NPI: 1902934151
Provider Name (Legal Business Name): BARBARA ERIKA POLIDURA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

402 ELDERBERRY DR
CLARKSVILLE TN
37043-6738
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7239
  • Fax: 931-920-7202
Mailing address:
  • Phone: 931-358-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: