Provider Demographics
NPI:1003690447
Name:BARRIOS, TED ALLAIRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:ALLAIRE
Last Name:BARRIOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:DOUGLAS
Other - Last Name:ALLAIRE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3956 CLOVERLANE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5059
Mailing Address - Country:US
Mailing Address - Phone:678-333-4856
Mailing Address - Fax:
Practice Address - Street 1:325 E EISENHOWER PKWY FL 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3364
Practice Address - Country:US
Practice Address - Phone:734-936-7052
Practice Address - Fax:734-936-7048
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019335103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist