Provider Demographics
NPI:1508055302
Name:PROCTOR, BARBARA ANN (MA, QMHP, LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MA, QMHP, LPC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:NUMEROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:573-708-7600
Mailing Address - Fax:573-723-1474
Practice Address - Street 1:112 MCCLURG AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556
Practice Address - Country:US
Practice Address - Phone:573-765-5141
Practice Address - Fax:573-765-3824
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL180007422101YP2500X
MO2020040389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1508055302Medicaid