Healthcare Provider Details

I. General information

NPI: 1386685683
Provider Name (Legal Business Name): TERRY P. BARNES, MS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W CENTER ST
HYDE PARK UT
84318-3201
US

IV. Provider business mailing address

PO BOX 436
HYDE PARK UT
84318-0436
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-0272
  • Fax: 435-753-2252
Mailing address:
  • Phone: 435-753-0272
  • Fax: 435-753-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number116331-3902
License Number StateUT

VIII. Authorized Official

Name: TERRY P. BARNES
Title or Position: PRESIDENT
Credential: LMFT
Phone: 435-753-0272