Provider Demographics
NPI:1073131751
Name:DERN, BARBARA (LPC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DERN
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 1:910 SE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9776
Mailing Address - Country:US
Mailing Address - Phone:479-208-7475
Mailing Address - Fax:
Practice Address - Street 1:910 SE 21ST ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9776
Practice Address - Country:US
Practice Address - Phone:479-208-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022034045101YP2500X
IDLPC-7727101YP2500X
ARP2307008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional