Provider Demographics
NPI:1396408464
Name:BARKER, ROY JR (LADC)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:BARKER
Suffix:JR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 COLFAX AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2031
Mailing Address - Country:US
Mailing Address - Phone:651-271-7944
Mailing Address - Fax:612-588-4991
Practice Address - Street 1:2651 COLFAX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2031
Practice Address - Country:US
Practice Address - Phone:651-271-7944
Practice Address - Fax:612-588-4991
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)