=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740435874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. TOM BARBER III
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2008
-----------------------------------------------------
Last Update Date | 11/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1756 S LEWIS RD
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-8520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-383-3669
-----------------------------------------------------
Fax | 805-987-5422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1030 W 9TH ST APT. 107
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030-6828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-383-3669
-----------------------------------------------------
Fax | 805-987-5422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------