Healthcare Provider Details

I. General information

NPI: 1023297942
Provider Name (Legal Business Name): WILLIAM BARNES JR. PHD., DCC. , LHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 18TH ST S
SAINT PETERSBURG FL
33712-3605
US

IV. Provider business mailing address

2255 18TH ST S
SAINT PETERSBURG FL
33712-3605
US

V. Phone/Fax

Practice location:
  • Phone: 727-374-2891
  • Fax:
Mailing address:
  • Phone: 727-374-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: