Healthcare Provider Details

I. General information

NPI: 1124172002
Provider Name (Legal Business Name): MARK EVERT BARNES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N FRUIT AVE STE 103
FRESNO CA
93711-3062
US

IV. Provider business mailing address

5080 NORTH FRUIT SUITE 103
FRESNO CA
93711-3204
US

V. Phone/Fax

Practice location:
  • Phone: 559-978-3339
  • Fax: 559-412-7207
Mailing address:
  • Phone: 559-978-3339
  • Fax: 559-412-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: