Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1811413354 |
---|---|
Provider Name | Mr. Gary L. Barclay |
First Address | Sedona, AZ 86351-7723 |
Second Address | Sedona, AZ 86351-7723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |