=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679663587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA E KHAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 S JEFFERSON ST
-----------------------------------------------------
City | NEOSHO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64850-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-451-4565
-----------------------------------------------------
Fax | 417-455-2916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2526
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64803-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-781-2410
-----------------------------------------------------
Fax | 417-781-4015
-----------------------------------------------------
=====================================================
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 | 2002010845
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------