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General NPI Number Information
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NPI Number | 1972829943
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Entity Type | Organization
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Legal Business Name | DEBRA CARTER-BARTH
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 303 1ST AVE NE STE 240
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City | FARIBAULT
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State | MN
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Zip | 55021-5268
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Country | US
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Telephone | 507-412-1468
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Fax | 507-331-8677
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Provider Business Mailing Address
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Address Line | 303 1ST AVE. N.E. STE 240
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City | FARIBAULT
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State | MN
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Zip | 55021-5379
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Country | US
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Telephone | 507-412-1468
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Fax | 507-331-8677
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Authorized Official
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Title or Position | PSYCHOTHERAPIST / OWNER
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Name | DEBRA LYNN CARTER-BARTH
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Credential | LICSW
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Telephone | 507-412-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 17263
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 17263
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License Number State | MN
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