Provider Demographics
NPI:1548834716
Name:BARRICK, PATRISH DOREEN
Entity type:Individual
Prefix:
First Name:PATRISH
Middle Name:DOREEN
Last Name:BARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 3RD S
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1636
Mailing Address - Country:US
Mailing Address - Phone:253-255-4061
Mailing Address - Fax:
Practice Address - Street 1:240 E 3RD S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1636
Practice Address - Country:US
Practice Address - Phone:253-255-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician