Provider Demographics
NPI:1821496647
Name:BARICEVIC, MARTI (LPC)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:BARICEVIC
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 1:2014 VANDALIA ST
Mailing Address - Street 2:FAMILY LIFE CONSULTANTS
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-345-9536
Mailing Address - Fax:618-345-9587
Practice Address - Street 1:27 MARILYN CIR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2853
Practice Address - Country:US
Practice Address - Phone:618-978-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist