Provider Demographics
NPI:1790856201
Name:BARRACLOUGH, DEBRA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:BARRACLOUGH
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 1:409 E ELDON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1607
Mailing Address - Country:US
Mailing Address - Phone:573-263-3494
Mailing Address - Fax:
Practice Address - Street 1:409 E ELDON ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1607
Practice Address - Country:US
Practice Address - Phone:573-263-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490638400Medicaid