Provider Demographics
NPI:1083486120
Name:BARNES, JOLENE ROSE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:ROSE
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24081 SANDY GLADE AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-5529
Mailing Address - Country:US
Mailing Address - Phone:951-525-1990
Mailing Address - Fax:
Practice Address - Street 1:9390 HESPERIA RD STE 2
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3636
Practice Address - Country:US
Practice Address - Phone:760-669-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-09-04
Deactivation Date:2024-07-29
Deactivation Code:
Reactivation Date:2024-09-04
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician