Provider Demographics
NPI:1679796767
Name:STALLARD, BARBARA FULTON (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:FULTON
Last Name:STALLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 ALLMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40209-1202
Mailing Address - Country:US
Mailing Address - Phone:502-424-8509
Mailing Address - Fax:
Practice Address - Street 1:4242 ALLMOND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40209-1202
Practice Address - Country:US
Practice Address - Phone:502-424-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32481041C0700X, 1041C0700X
KY0780106H00000X
IN34005707A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100390110Medicaid
KY1211515OtherCAQH
KY1679796767Medicare UPIN