Provider Demographics
NPI:1750411419
Name:BERRY, BARBARA KOHLER (LPC 0207 LISAC 0169)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:KOHLER
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPC 0207 LISAC 0169
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E LAGUNA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-838-1700
Mailing Address - Fax:
Practice Address - Street 1:11011 S 48TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1779
Practice Address - Country:US
Practice Address - Phone:480-838-1700
Practice Address - Fax:480-753-0060
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC0169101YA0400X
AZLPC0207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional