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General NPI Number Information
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NPI Number | 1710313952
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Entity Type | Organization
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Legal Business Name | JK BARTON INCORPORATED
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 1901 MEDI PARK DR STE 212
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City | AMARILLO
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State | TX
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Zip | 79106-2107
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Country | US
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Telephone | 806-418-2283
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Fax | 806-418-2285
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Provider Business Mailing Address
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Address Line | 1901 MEDI PARK DR STE 212
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City | AMARILLO
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State | TX
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Zip | 79106-2107
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Country | US
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Telephone | 806-418-2283
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Fax | 806-418-2285
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Authorized Official
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Title or Position | OWNER/LPC
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Name | MRS. KRISTIN NEALIE WYLIE
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Credential | LPC
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Telephone | 806-418-2283
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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 | 67639
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License Number State | TX
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