Provider Demographics
NPI:1710590260
Name:BARBER, MARY DAVIS
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DAVIS
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NW 169TH PL STE C100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7362
Mailing Address - Country:US
Mailing Address - Phone:503-747-2587
Mailing Address - Fax:503-746-6323
Practice Address - Street 1:1800 NW 169TH PL STE C100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7362
Practice Address - Country:US
Practice Address - Phone:503-747-2587
Practice Address - Fax:503-746-6323
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10204956106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician