Provider Demographics
NPI:1396081139
Name:BARRETT, ARLENE MACKLEY (MA)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:MACKLEY
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 N DE SOTO ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2136
Mailing Address - Country:US
Mailing Address - Phone:801-638-8137
Mailing Address - Fax:801-606-7793
Practice Address - Street 1:588 N DE SOTO ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2136
Practice Address - Country:US
Practice Address - Phone:801-638-8137
Practice Address - Fax:801-606-7793
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75856763902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist