Provider Demographics
NPI:1992232318
Name:BARRETT, SIMARA DESHUN
Entity type:Individual
Prefix:
First Name:SIMARA
Middle Name:DESHUN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 WEST PARK AVE
Mailing Address - Street 2:SUITE Q-R
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930
Mailing Address - Country:US
Mailing Address - Phone:662-374-5029
Mailing Address - Fax:662-374-5032
Practice Address - Street 1:522 WEST PARK AVE
Practice Address - Street 2:SUITE Q-R
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-374-5029
Practice Address - Fax:662-374-5032
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker