MEDICARE: CLARISSA SUE BARNES M.S., BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558645424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA SUE BARNES M.S., BCBA

Provider Business Mailing Address
First Line	:	1245 E GRAND AVE
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-3600
Country	:	US
Telephone Number	:	618-457-0371
Fax Number	:	618-529-1248

Provider Business Practice Location Address
First Line	:	1245 E GRAND AVE
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-3600
Country	:	US
Telephone Number	:	618-457-0371
Fax Number	:	618-529-1248

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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