Provider Demographics
NPI:1174129795
Name:BARNHART, MARIE (MED, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BARNHART
Suffix:
Gender:F
Credentials:MED, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E GRANT HWY # 704
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3371
Mailing Address - Country:US
Mailing Address - Phone:872-205-6167
Mailing Address - Fax:
Practice Address - Street 1:223 E GRANT HWY # 704
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3371
Practice Address - Country:US
Practice Address - Phone:872-205-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X
IL180013622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health