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General NPI Number Information
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NPI Number | 1467052399
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Entity Type | Individual
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Provider Name | KASIIM SHAKIR BARR
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 640 DR MARY MCLEOD BETHUNE BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3012
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Country | US
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Telephone | 407-591-9502
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Fax |
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Provider Business Mailing Address
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Address Line | 4474 GOLDENRAIN CT
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City | ORLANDO
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State | FL
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Zip | 32808-1771
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Country | US
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Telephone | 407-591-9502
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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