MEDICARE: MS. ANGIE PATRICE BARNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1457680761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGIE PATRICE BARNES

Provider Business Mailing Address
First Line	:	5045 W SIERRA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-3603
Country	:	US
Telephone Number	:	559-709-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 W SIERRA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-3603
Country	:	US
Telephone Number	:	559-709-7784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	12/15/2009

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