Basic Information
| Provider Information | |||||||||
| NPI: | 1821763715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARROW | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | MARSHALL | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 S 4TH ST BLDG 122 | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4101 S 4TH ST BLDG 122 | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2021 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS01983 | RI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | PS01983 | RI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.