Provider Demographics
NPI:1194284265
Name:BARNETT, JEREMIAH PRECIOUS (PHD, ALC)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:PRECIOUS
Last Name:BARNETT
Suffix:
Gender:M
Credentials:PHD, ALC
Other - Prefix:DR
Other - First Name:JEREMIAH
Other - Middle Name:PRECIOUS
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7084 RUNNYMEDE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6706
Mailing Address - Country:US
Mailing Address - Phone:334-313-2523
Mailing Address - Fax:334-323-6051
Practice Address - Street 1:8449 CROSSLAND LOOP STE 121
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-0919
Practice Address - Country:US
Practice Address - Phone:334-313-2523
Practice Address - Fax:334-323-6051
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1740559020Medicaid