Provider Demographics
NPI:1003119454
Name:BARRATT, REBECCA J
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:BARRATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S EASTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2146
Mailing Address - Country:US
Mailing Address - Phone:417-763-3309
Mailing Address - Fax:417-763-3331
Practice Address - Street 1:2131 S EASTGATE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-2146
Practice Address - Country:US
Practice Address - Phone:417-763-3309
Practice Address - Fax:417-763-3331
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional