Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 581010 | MS |
Y | 103T00000X | Psychologist | 581010 | MS |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 581010 | MS |
NPI | 1548771611 |
---|---|
Provider Name | Daniel Barnes |
First Address | Jackson, MS 39296-4436 |
Second Address | Jackson, MS 39216-5116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 17/03/2018 |