Provider Demographics
NPI:1417422148
Name:BARRY, ANGELA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:BARRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N CENTRAL AVE PMB 256
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5927
Mailing Address - Country:US
Mailing Address - Phone:541-236-9959
Mailing Address - Fax:
Practice Address - Street 1:328 S CENTRAL AVE STE 210
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7274
Practice Address - Country:US
Practice Address - Phone:541-236-9959
Practice Address - Fax:541-314-9430
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7657101YM0800X
ORR5913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health