Provider Demographics
NPI:1568722718
Name:BARRY, PHILLIP D (LPC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:BARRY
Suffix:
Gender:M
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:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-286-9860
Mailing Address - Fax:662-286-8095
Practice Address - Street 1:301 S CASS ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6109
Practice Address - Country:US
Practice Address - Phone:662-286-9860
Practice Address - Fax:662-286-8095
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1905101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018207Medicaid