Healthcare Provider Details

I. General information

NPI: 1831425537
Provider Name (Legal Business Name): KATHY D. BARNETT, PHD. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MURRAY HOLLADAY RD SUITE 211
HOLLADAY UT
84117-5185
US

IV. Provider business mailing address

PO BOX 17661
HOLLADAY UT
84117-0661
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-5083
  • Fax:
Mailing address:
  • Phone: 801-243-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number212620-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number212620-2501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2126202501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number212620-2501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number212620-2501
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number212620-2501
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number212620-2501
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number212620-2501
License Number StateUT

VIII. Authorized Official

Name: DR. KATHY D. BARNETT
Title or Position: OWNER/MANAGER
Credential: PH.D.
Phone: 801-243-2273