Healthcare Provider Details

I. General information

NPI: 1679215263
Provider Name (Legal Business Name): SABLE BARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 E WARNER RD STE 203
GILBERT AZ
85296-3066
US

IV. Provider business mailing address

6998 S WILSON DR
CHANDLER AZ
85249-5071
US

V. Phone/Fax

Practice location:
  • Phone: 480-495-9054
  • Fax:
Mailing address:
  • Phone: 928-899-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-17088
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: