Healthcare Provider Details

I. General information

NPI: 1114395191
Provider Name (Legal Business Name): TIA BARNESLEWIS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA BARNES

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date: 04/27/2020
Reactivation Date: 08/28/2023

III. Provider practice location address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

IV. Provider business mailing address

20993 FOOTHILL BLVD
CHERRYLAND CA
94541-1511
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax: 510-530-8083
Mailing address:
  • Phone: 510-545-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: