MEDICARE: WANDA BARNES PHD., , LMHCI

Medicare Provider Information

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
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	MH10356	FL

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

NPI Number	:	1588843403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA BARNES PHD., , LMHCI

Provider Business Mailing Address
First Line	:	2255 18TH ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-3605
Country	:	US
Telephone Number	:	727-374-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 5TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-7521
Country	:	US
Telephone Number	:	727-367-2273
Fax Number	:	727-800-6929

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	11/13/2023

3840 5TH AVE N
SAINT PETERSBURG, FL
33713-7521

Practice Phone: 727-367-2273
Practice Fax: 727-800-6929

3840 5TH AVE N
SAINT PETERSBURG, FL
33713-7521