Healthcare Provider Details

I. General information

NPI: 1467079525
Provider Name (Legal Business Name): GWENDOLYN SPENCER BARNHART PH.D., M.S., M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 11/05/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 DIVISION ST.
NOME AK
99762
US

IV. Provider business mailing address

607 DIVISION ST.
NOME AK
99762
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61254557
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61265998
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: