Provider Demographics
NPI:1073963963
Name:BARBER, STACY JO (LCPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:BARBER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9027
Mailing Address - Country:US
Mailing Address - Phone:773-930-0994
Mailing Address - Fax:
Practice Address - Street 1:820 COLONY RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9027
Practice Address - Country:US
Practice Address - Phone:773-930-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional