Provider Demographics
NPI:1164792396
Name:BARRY, EMILY (LPC, CADCI)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:LPC, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2610
Mailing Address - Country:US
Mailing Address - Phone:541-231-2193
Mailing Address - Fax:
Practice Address - Street 1:971 NW SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2234
Practice Address - Country:US
Practice Address - Phone:541-231-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2784101Y00000X
OR070603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)