Provider Demographics
NPI:1104388651
Name:BARACK, PLLC
Entity Type:Organization
Organization Name:BARACK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:240-701-8809
Mailing Address - Street 1:PO BOX 11308
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-1308
Mailing Address - Country:US
Mailing Address - Phone:240-701-8809
Mailing Address - Fax:256-952-9033
Practice Address - Street 1:3109 GAYHART DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3067
Practice Address - Country:US
Practice Address - Phone:256-500-9933
Practice Address - Fax:256-952-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty