Provider Demographics
NPI:1699308049
Name:BARR, COLLETTE (APRDH)
Entity type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:APRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 E GARNET CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3266
Mailing Address - Country:US
Mailing Address - Phone:480-830-9555
Mailing Address - Fax:
Practice Address - Street 1:3581 W NORTHERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9404
Practice Address - Country:US
Practice Address - Phone:480-830-9555
Practice Address - Fax:480-499-0083
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 261Q00000X, 374J00000X
AZH3090124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No374J00000XNursing Service Related ProvidersDoula