Provider Demographics
NPI:1245316207
Name:MODISETTE, BARBARA JANE (EDD, LPC, NCSP,)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JANE
Last Name:MODISETTE
Suffix:
Gender:F
Credentials:EDD, LPC, NCSP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1207
Mailing Address - Country:US
Mailing Address - Phone:903-759-6147
Mailing Address - Fax:903-759-4948
Practice Address - Street 1:3601 GILMER RD
Practice Address - Street 2:101
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1220
Practice Address - Country:US
Practice Address - Phone:903-759-6147
Practice Address - Fax:903-759-4948
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5880101YP2500X
TX31654103TS0200X, 251300000X
TX9559101YP2500X, 251300000X
TX6712-01103K00000X, 251300000X
TX29020103TS0200X, 251300000X
TX0142103TM1800X, 251300000X
TX10134251300000X
TX05880251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No251300000XAgenciesLocal Education Agency (LEA)