Provider Demographics
NPI:1679618276
Name:CLICK, BARRY CLINTON (DOCTOR OF MINISTRY)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:CLINTON
Last Name:CLICK
Suffix:
Gender:M
Credentials:DOCTOR OF MINISTRY
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:CLINTON
Other - Last Name:CLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMIN
Mailing Address - Street 1:135 AZALEA TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7924
Mailing Address - Country:US
Mailing Address - Phone:601-992-9960
Mailing Address - Fax:601-974-6260
Practice Address - Street 1:1225 N STATE ST STE 210
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-973-1697
Practice Address - Fax:601-974-6260
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional