Provider Demographics
NPI:1376770438
Name:BARKER, FRED P (LPC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:P
Last Name:BARKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COYOTE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-1360
Mailing Address - Country:US
Mailing Address - Phone:636-485-0470
Mailing Address - Fax:
Practice Address - Street 1:24 W MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1600
Practice Address - Country:US
Practice Address - Phone:636-486-6359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005041410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional