Provider Demographics
NPI:1487900775
Name:BARNES, BRIAN (CSWA, MAC, CADC III)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:CSWA, MAC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 W BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3514
Mailing Address - Country:US
Mailing Address - Phone:971-271-6142
Mailing Address - Fax:
Practice Address - Street 1:727 W BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3514
Practice Address - Country:US
Practice Address - Phone:971-271-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-05-17101YA0400X, 101YA0400X
OR101YM0800X
ORA46041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical