Provider Demographics
NPI:1427219716
Name:BARBOUR, FAYETTE LYNN (LISW)
Entity Type:Individual
Prefix:
First Name:FAYETTE
Middle Name:LYNN
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2264
Mailing Address - Country:US
Mailing Address - Phone:505-321-9828
Mailing Address - Fax:
Practice Address - Street 1:2 ELM POINT RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5766
Practice Address - Country:US
Practice Address - Phone:505-321-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI053801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical