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NPI Code Detail

MEDICARE: DR. MARC W BARNES PH.D, CADAC IV

MEDICARE: DR. MARC W BARNES PH.D, CADAC IV
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3101YP1600XPastoral Counselor
4103T00000XPsychologist
5103TE1100XExercise & Sports Psychologist
6103TF0000XFamily Psychologist

General Provider Information

NPI Number : 1912095548
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC W BARNES PH.D, CADAC IV
Provider Business Mailing Address
First Line : 3518 MAXIM DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-6131
Country : US
Telephone Number : 260-385-0513
Fax Number : 866-799-4012
Provider Business Practice Location Address
First Line : 2821 HILLEGAS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46808-3859
Country : US
Telephone Number : 260-471-1950
Fax Number : 260-471-1950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 09/11/2025

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