Provider Demographics
NPI:1134465503
Name:BARRON, KELLY GLENN (BA, TCM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GLENN
Last Name:BARRON
Suffix:
Gender:F
Credentials:BA, TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 NW 6TH ST STE 1-A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8554
Mailing Address - Country:US
Mailing Address - Phone:352-264-8152
Mailing Address - Fax:
Practice Address - Street 1:1731 NW 6TH ST STE 1-A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8554
Practice Address - Country:US
Practice Address - Phone:352-264-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker