MEDICARE: BARBARA BARRY, A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1639643364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBARA BARRY, A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3770 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3252
Country	:	US
Telephone Number	:	208-473-1176
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3252
Country	:	US
Telephone Number	:	208-473-1176
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA A BARRY
Credential	:
Telephone Number	:	607-567-8714

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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