Healthcare Provider Details

I. General information

NPI: 1295057792
Provider Name (Legal Business Name): MR. GARY DAVID BARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 155TH ST SUITE 103
GARDENA CA
90247-4048
US

IV. Provider business mailing address

1300 W 155TH ST SUITE 103
GARDENA CA
90247-4048
US

V. Phone/Fax

Practice location:
  • Phone: 310-512-8100
  • Fax: 310-324-2111
Mailing address:
  • Phone: 310-512-8100
  • Fax: 310-324-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: