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General NPI Number Information
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NPI Number | 1104388651
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Entity Type | Organization
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Legal Business Name | BARACK, PLLC
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 3109 GAYHART DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35810-3067
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Country | US
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Telephone | 256-500-9933
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Fax | 256-952-9033
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Provider Business Mailing Address
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Address Line | PO BOX 11308
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City | HUNTSVILLE
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State | AL
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Zip | 35814-1308
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Country | US
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Telephone | 240-701-8809
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Fax | 256-952-9033
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. JENNIFER PARKER AYERS
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Credential | PHD, LPC
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Telephone | 240-701-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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