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General NPI Number Information
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NPI Number | 1003599077
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Entity Type | Individual
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Provider Name | NICHOLAS PRESTON BARRY LSW
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Gender | Male
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 20550 S LA GRANGE RD STE 105
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City | FRANKFORT
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State | IL
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Zip | 60423-1273
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Country | US
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Telephone | 331-758-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 16730 BEVERLY AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-2951
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Country | US
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Telephone | 708-517-3120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.030912
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.111555
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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