Provider Demographics
NPI:1194897140
Name:MARTIN, BARBARA BOSS (LPC LMFT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:BOSS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KEITH LANE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:601-924-2041
Mailing Address - Fax:601-923-1634
Practice Address - Street 1:5422 CLINTON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209
Practice Address - Country:US
Practice Address - Phone:601-923-1635
Practice Address - Fax:601-923-1634
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0618101Y00000X
MST0192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist