Provider Demographics
NPI:1750947701
Name:BARBER, MONIQUE VICTORIA (PHD, LPC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:VICTORIA
Last Name:BARBER
Suffix:
Gender:
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W STATE ST STE D
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6428
Mailing Address - Country:US
Mailing Address - Phone:208-398-3431
Mailing Address - Fax:208-986-3015
Practice Address - Street 1:6001 W STATE ST STE D
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83703-6428
Practice Address - Country:US
Practice Address - Phone:208-398-3431
Practice Address - Fax:208-986-3015
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101Y00000X, 101YM0800X
ID7321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDZD270419DOtherDRIVERS LICENSE