Healthcare Provider Details

I. General information

NPI: 1851701627
Provider Name (Legal Business Name): MODERN TREATMENT HEALTHCARE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST W STE 9
VALDESE NC
28690
US

IV. Provider business mailing address

92 EDGEWATER RD
HICKORY NC
28601-8661
US

V. Phone/Fax

Practice location:
  • Phone: 980-643-1943
  • Fax:
Mailing address:
  • Phone: 980-643-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2058
License Number StateNC

VIII. Authorized Official

Name: DR. KYLE W BARNES
Title or Position: CEO
Credential: LPA, LPC, EDD
Phone: 980-643-1943