Provider Demographics
NPI:1255757324
Name:LANDON, BARRY ROBERT (MA)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:ROBERT
Last Name:LANDON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:363 STOKENBURY ROAD
Mailing Address - City:ELKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72727-0335
Mailing Address - Country:US
Mailing Address - Phone:479-200-9426
Mailing Address - Fax:
Practice Address - Street 1:823 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2914
Practice Address - Country:US
Practice Address - Phone:870-741-2960
Practice Address - Fax:870-741-2965
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158658526Medicaid