Provider Information for 1295385565
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BARRY LARSON PARKER LCSW
Sex: Male
NPI: 1295385565
Last Updated: 2020-08-03
Certification Date: 2020-08-03
Certification Date: 2020-08-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1295385565 | ||||||||
| Enumeration Date | 2019-09-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 10299 FORT WAYNE, IN 46851-0299 United States Phone: 574-546-1900 | Fax:574-546-1999 | ||||||||
| Primary Practice Address | 2100 N MAIN ST STE 304 CROWN POINT, IN 46307-1877 United States Phone: 574-546-1900 | Fax:574-546-1999 | ||||||||
| Secondary Practice Address(es) | 101 S 5TH ST STE 2500 | ||||||||
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