Basic Information
| Provider Information | |||||||||
| NPI: | 1699075846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W NORFOLK AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023792030 | ||||||||
| FaxNumber: | 4023793933 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W NORFOLK AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023792030 | ||||||||
| FaxNumber: | 4023793933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 10/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9257 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 391874354 | 05 | NE | MEDICAID |