Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003071630 |
---|---|
Provider Name | Micah Robert Barker |
First Address | Sapulpa, OK 74066-3607 |
Second Address | Sapulpa, OK 74066-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 14/04/2017 |