MEDICARE: BARNETT COUNSELING SERVICES PLLC

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	1041C0700X	Clinical Social Worker	3508	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467830067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNETT COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-778-0700
Fax Number	:	405-778-4484

Provider Business Practice Location Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-778-0700
Fax Number	:	405-778-4484

Authorized Official
Title or Position	:	OWNER
Name	:	MICAH GRAVES-BARNETT
Credential	:	LCSW
Telephone Number	:	405-778-0700

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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