Provider Demographics
NPI:1346488160
Name:COUNTZ, BARBARA J (MED/LPC CANDIDA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:COUNTZ
Suffix:
Gender:F
Credentials:MED/LPC CANDIDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH MAIN STREET
Mailing Address - Street 2:PARENTS' CLUB, INC.
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501
Mailing Address - Country:US
Mailing Address - Phone:918-302-0909
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH MAIN STREET
Practice Address - Street 2:PARENTS' CLUB, INC.
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-302-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCANDIDATE101YP2500X
OK133823101YS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool