Provider Demographics
NPI:1558104547
Name:BARNES, RACHEAL
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
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 1:1014 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1513
Mailing Address - Country:US
Mailing Address - Phone:810-973-5012
Mailing Address - Fax:800-205-9989
Practice Address - Street 1:1014 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1513
Practice Address - Country:US
Practice Address - Phone:810-973-5012
Practice Address - Fax:800-205-9989
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician