MEDICARE: MRS. MARTHA STOVER BARLOW M.S., LPC

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	0701000717	VA

General Provider Information

NPI Number	:	1902113970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA STOVER BARLOW M.S., LPC

Provider Business Mailing Address
First Line	:	5163 OTTOBINE RD
Second Line	:
City	:	DAYTON
State	:	VA
Zip	:	22821-2908
Country	:	US
Telephone Number	:	540-879-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	5163 OTTOBINE RD
Second Line	:
City	:	DAYTON
State	:	VA
Zip	:	22821-2908
Country	:	US
Telephone Number	:	540-280-5180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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