Healthcare Provider Details

I. General information

NPI: 1891036992
Provider Name (Legal Business Name): CHRISTOPHER L. BARNES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 N MAIN ST STE C
THREE RIVERS MI
49093-1377
US

IV. Provider business mailing address

1519 N MAIN ST STE C
THREE RIVERS MI
49093-1377
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-2024
  • Fax:
Mailing address:
  • Phone: 269-273-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014791
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CHRISTOPHER LEE BARNES
Title or Position: PRESIDENT/CEO
Credential: PSYD
Phone: 269-273-2024