Provider Demographics
NPI:1083953038
Name:BARNES, M JEANNETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:M
Middle Name:JEANNETTE
Last Name:BARNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-6718
Mailing Address - Country:US
Mailing Address - Phone:214-621-3545
Mailing Address - Fax:817-255-7166
Practice Address - Street 1:1518 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6718
Practice Address - Country:US
Practice Address - Phone:214-621-3545
Practice Address - Fax:817-255-7166
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01207104100000X
TXS112071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker