Mary Lisa Barta LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

35001710A Issued in IN

Legal business name

MARY LISA BARTA LLC

Practice address

5630 The Prophets Pass
Fort Wayne, IN 46845-9473

Phone

(260) 471-1662

NPI assigned

Jan 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Lisa BartaNPI 1972769735

Title

Owner/Manager

Phone

(260) 471-1662

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Lisa Barta, MS, LMFTA

  • Marriage & Family Therapist
  • Fort Wayne, IN
  • NPI 1972769735
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1922497775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5630 THE PROPHETS PASS",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468459473",
            "telephone_number": "260-471-1662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5630 THE PROPHETS PASS",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468459473",
            "telephone_number": "260-471-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LISA BARTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "last_updated": "2015-01-16",
        "status": "A",
        "authorized_official_last_name": "BARTA",
        "authorized_official_first_name": "MARY LISA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "260-471-1662"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "IN",
            "license": "35001710A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Marriage & Family Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.