Basic Information
| Provider Information | |||||||||
| NPI: | 1700432028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | EARL | ||||||||
| MiddleName: | DEPORRES | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ADDICTION COUNSELOR | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WHITE ST | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012494214 | ||||||||
| FaxNumber: | 6012494234 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 WHITE ST | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012494214 | ||||||||
| FaxNumber: | 6012494234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2019 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1038 | LA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.