Provider Demographics
NPI:1073131751
Name:DERN, BARBARA (LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DERN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 W WALNUT ST # 1149
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1842
Mailing Address - Country:US
Mailing Address - Phone:479-208-7475
Mailing Address - Fax:
Practice Address - Street 1:13 CELTIC DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-2001
Practice Address - Country:US
Practice Address - Phone:792-087-4754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022034045101YP2500X
IDLPC-7727101YP2500X
ARP2307008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional