Healthcare Provider Details

I. General information

NPI: 1164835179
Provider Name (Legal Business Name): HOLLY BARNARD, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7577 CENTRAL PARKE BLVD SUITE 109
MASON OH
45040-6810
US

IV. Provider business mailing address

7577 CENTRAL PARKE BLVD SUITE 109
MASON OH
45040-6810
US

V. Phone/Fax

Practice location:
  • Phone: 303-524-5552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6816
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6816
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6816
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6816
License Number StateOH

VIII. Authorized Official

Name: HOLLY BARNARD
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 303-524-5552