Basic Information
| Provider Information | |||||||||
| NPI: | 1659559565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DAYN | ||||||||
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| Credential: | LPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709359911 | ||||||||
| FaxNumber: | 8709353450 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709359911 | ||||||||
| FaxNumber: | 8709353450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 07-18AE-PL | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 07-18AE-PL | 01 | AR | ARKANSAS PSYCHOLOGY BOARD | OTHER |