Basic Information
Provider Information
NPI: 1750670345
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARBEE
FirstName: MARCO
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 347 MIDWAY BLVD STE 200
Address2:  
City: ELYRIA
State: OH
PostalCode: 440352496
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 347 MIDWAY BLVD STE 200
Address2:  
City: ELYRIA
State: OH
PostalCode: 440352496
CountryCode: US
TelephoneNumber: 4403245701
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/04/2011
LastUpdateDate: 04/04/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XE.0501022OHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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