Basic Information
Provider Information
NPI: 1265037766
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARKER
FirstName: MARIA
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 934 S MAIN ST
Address2:  
City: LAYTON
State: UT
PostalCode: 840417135
CountryCode: US
TelephoneNumber: 8017737060
FaxNumber: 8013361787
Practice Location
Address1: 934 S MAIN ST
Address2:  
City: LAYTON
State: UT
PostalCode: 840417135
CountryCode: US
TelephoneNumber: 8017737060
FaxNumber: 8013361787
Other Information
ProviderEnumerationDate: 12/02/2020
LastUpdateDate: 12/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X124100-3501UTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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