Basic Information
| Provider Information | |||||||||
| NPI: | 1669504460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNUM | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CADC-II | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 810 | ||||||||
| Address2: | |||||||||
| City: | BROWNS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959180810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306928914 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1251 E ONSTOTT RD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959912439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227263 | ||||||||
| FaxNumber: | 5308227267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A4001107 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.