Provider Demographics
NPI:1558706085
Name:BARKER, NICOLE M (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BARKER
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 1:2702 SAVOY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1110
Mailing Address - Country:US
Mailing Address - Phone:636-578-2586
Mailing Address - Fax:
Practice Address - Street 1:24 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1665
Practice Address - Country:US
Practice Address - Phone:636-344-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013008414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional