Provider Demographics
NPI:1881459154
Name:EGBERT, BARBARA GAY (LAC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:GAY
Last Name:EGBERT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:EGBERT
Other - Last Name:HETTINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:915 W WHY WORRY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4474
Mailing Address - Country:US
Mailing Address - Phone:602-670-7812
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6688
Practice Address - Country:US
Practice Address - Phone:382-125-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health