Healthcare Provider Details

I. General information

NPI: 1851592679
Provider Name (Legal Business Name): WILLIAM RUSS BARNETTE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 7TH AVE
JASPER AL
35501-4377
US

IV. Provider business mailing address

701 LAUREL LN
JASPER AL
35504-7477
US

V. Phone/Fax

Practice location:
  • Phone: 205-302-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1525
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: