=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255450185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY BARROW LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3937 WESTERN BLVD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27606-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-821-0791
-----------------------------------------------------
Fax | 919-861-8961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 33393
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27636-3393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-821-0790
-----------------------------------------------------
Fax | 919-861-8961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5267
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------