Healthcare Provider Details

I. General information

NPI: 1962672907
Provider Name (Legal Business Name): JOE CHRIS BARNES MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 SYLVAN ST
VAN NUYS CA
91411-2324
US

IV. Provider business mailing address

11468 VANPORT AVE
LAKE VIEW TERRACE CA
91342-7140
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-4151
  • Fax:
Mailing address:
  • Phone: 818-277-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: