Provider Demographics
NPI:1093112740
Name:BARKER, PHILIP RAYMOND (LMSW, ACSW, SSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:RAYMOND
Last Name:BARKER
Suffix:
Gender:M
Credentials:LMSW, ACSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 SPRING ARBOR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3652
Mailing Address - Country:US
Mailing Address - Phone:517-788-8330
Mailing Address - Fax:517-788-9768
Practice Address - Street 1:2575 SPRING ARBOR RD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3652
Practice Address - Country:US
Practice Address - Phone:517-788-8330
Practice Address - Fax:517-788-9768
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059321104100000X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI8809001Medicaid