MEDICARE: JANA S BARNES M,ED, BHRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist		OK

General Provider Information

NPI Number	:	1164682910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA S BARNES M,ED, BHRS

Provider Business Mailing Address
First Line	:	721 S GEORGE NIGH EXPY
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-7400
Country	:	US
Telephone Number	:	918-302-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 S GEORGE NIGH EXPY
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-7400
Country	:	US
Telephone Number	:	918-302-0909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	10/10/2011

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