Provider Demographics
NPI:1992859029
Name:FALLS, JACQUELINE O BARR (MED)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:O BARR
Last Name:FALLS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:JACKIE
Other - Middle Name:O BARR
Other - Last Name:FALLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:59 RIVERBEND CIR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-8335
Mailing Address - Country:US
Mailing Address - Phone:256-571-0448
Mailing Address - Fax:205-972-3660
Practice Address - Street 1:116 LILY FLAGG ROAD SW
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-881-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL941101YP2500X
AL12106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL43250OtherBLUE CROSS BS OF AL