# MARY LISA BARTA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922497775
- **Authorized official:** MARY LISA BARTA (OWNER/MANAGER)
- **Authorized official phone:** (260) 471-1662

## Contact information

- **Practice address:** 5630 THE PROPHETS PASS, FORT WAYNE, IN 46845-9473
- **Practice address phone:** (260) 471-1662
- **Mailing address:** 5630 THE PROPHETS PASS, FORT WAYNE, IN 46845-9473
- **Mailing address phone:** (260) 471-1662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 35001710A | IN | Yes |

## Other

- **Enumeration date:** 01/16/2015
- **Last updated:** 01/16/2015