| Mary Lisa Barta Llc | |
|
5630 The Prophets Pass Fort Wayne IN 46845-9473 | |
| (260) 471-1662 | |
| Not Available |
| Full Name | Mary Lisa Barta Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5630 The Prophets Pass, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mary Lisa Barta (OWNER/MANAGER) |
| Authorized Official Contact | 2604711662 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lisa Barta Llc 5630 The Prophets Pass Fort Wayne IN 46845-9473 Ph: (260) 471-1662 | Mary Lisa Barta Llc 5630 The Prophets Pass Fort Wayne IN 46845-9473 Ph: (260) 471-1662 |
| NPI Number | 1922497775 |
|---|---|
| Provider Enumeration Date | 01/16/2015 |
| Last Update Date | 01/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922497775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 35001710A (Indiana) | Primary |
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