Provider Demographics
NPI:1194439190
Name:BARNETT, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510A WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1148
Mailing Address - Country:US
Mailing Address - Phone:864-509-0774
Mailing Address - Fax:
Practice Address - Street 1:2510A WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1148
Practice Address - Country:US
Practice Address - Phone:864-509-0774
Practice Address - Fax:877-629-7598
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist