Provider Demographics
NPI:1073767364
Name:BARNESS, BONNIE MELANIE (LISAC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MELANIE
Last Name:BARNESS
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11429 E ASTER DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2513
Mailing Address - Country:US
Mailing Address - Phone:480-451-0407
Mailing Address - Fax:
Practice Address - Street 1:9929 N 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4592
Practice Address - Country:US
Practice Address - Phone:480-451-0407
Practice Address - Fax:480-451-0407
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)