Provider Demographics
NPI:1508303264
Name:BARRETT, ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 STATE HIGHWAY RA
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-7808
Mailing Address - Country:US
Mailing Address - Phone:573-317-6829
Mailing Address - Fax:
Practice Address - Street 1:304 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GRAVOIS MILLS
Practice Address - State:MO
Practice Address - Zip Code:65037-6257
Practice Address - Country:US
Practice Address - Phone:573-317-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017023921171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist