Provider Demographics
NPI:1003428046
Name:BARBER, MARIKA RAI
Entity Type:Individual
Prefix:MS
First Name:MARIKA
Middle Name:RAI
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MIKA
Other - Middle Name:RAI
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2216 E LAURI KAY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3604
Mailing Address - Country:US
Mailing Address - Phone:801-916-2001
Mailing Address - Fax:
Practice Address - Street 1:3280 W 3500 S STE E
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-2668
Practice Address - Country:US
Practice Address - Phone:801-979-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty