Provider Demographics
NPI:1285982629
Name:BARNETT, DOUGLAS M (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:M
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 NORTHLAKE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6270
Mailing Address - Country:US
Mailing Address - Phone:561-624-7941
Mailing Address - Fax:
Practice Address - Street 1:4362 NORTHLAKE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6270
Practice Address - Country:US
Practice Address - Phone:561-624-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10149101YM0800X
FLMH13141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070525000Medicaid