Provider Demographics
NPI:1063774677
Name:MONTICA A. O'BARR
Entity type:Organization
Organization Name:MONTICA A. O'BARR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:O'BARR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:972-268-7030
Mailing Address - Street 1:206 YMCA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5242
Mailing Address - Country:US
Mailing Address - Phone:972-268-7030
Mailing Address - Fax:469-517-1138
Practice Address - Street 1:206 YMCA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5242
Practice Address - Country:US
Practice Address - Phone:972-268-7030
Practice Address - Fax:469-517-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-10
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11881251S00000X
TX69764251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YP2500XOtherTAX ID