Provider Demographics
NPI:1053476697
Name:SEARLE, BARBARA S (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:SEARLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3035
Mailing Address - Country:US
Mailing Address - Phone:574-237-1003
Mailing Address - Fax:574-237-1006
Practice Address - Street 1:3603 E JEFFERSON BLVD
Practice Address - Street 2:SUITEB
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3035
Practice Address - Country:US
Practice Address - Phone:574-237-1003
Practice Address - Fax:574-237-1006
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041598A103TC0700X
IL071006697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402930AMedicaid
IN200402930AMedicaid