Provider Demographics
NPI:1225540016
Name:BARRETT, SEAN RAYMOND (IMFT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:RAYMOND
Last Name:BARRETT
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BELLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3638
Mailing Address - Country:US
Mailing Address - Phone:937-376-8526
Mailing Address - Fax:
Practice Address - Street 1:7031 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2537
Practice Address - Country:US
Practice Address - Phone:888-471-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.1600010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist