Healthcare Provider Details

I. General information

NPI: 1154564805
Provider Name (Legal Business Name): JODI L BARNES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 SOUTH TRUMBULL
BAY CITY MI
48708
US

IV. Provider business mailing address

690 SOUTH TRUMBULL
BAY CITY MI
48708
US

V. Phone/Fax

Practice location:
  • Phone: 989-922-4900
  • Fax: 989-922-4911
Mailing address:
  • Phone: 989-922-4900
  • Fax: 989-922-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: