Provider Demographics
NPI:1881179091
Name:BARRY J. BOUILLION JR., MA, LPC, LMFT, LLC
Entity type:Organization
Organization Name:BARRY J. BOUILLION JR., MA, LPC, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOUILLION
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:601-398-6797
Mailing Address - Street 1:317 KNOTTS CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4569
Mailing Address - Country:US
Mailing Address - Phone:601-398-6797
Mailing Address - Fax:
Practice Address - Street 1:3380 TRICKUM RD BLDG 700
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3680
Practice Address - Country:US
Practice Address - Phone:601-398-6797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health