Provider Demographics
NPI:1356184543
Name:BARBER, JEROME LATEEK (LCDC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:LATEEK
Last Name:BARBER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 E NASA PKWY APT 115B
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-5533
Mailing Address - Country:US
Mailing Address - Phone:346-339-4288
Mailing Address - Fax:
Practice Address - Street 1:4601 E NASA PKWY APT 115B
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-5533
Practice Address - Country:US
Practice Address - Phone:346-339-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363-0124175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist