Provider Demographics
NPI:1164635314
Name:BARNES, GARY L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:BARNES
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 SW MADISON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4589
Mailing Address - Country:US
Mailing Address - Phone:541-752-9826
Mailing Address - Fax:866-905-8115
Practice Address - Street 1:760 SW MADISON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4589
Practice Address - Country:US
Practice Address - Phone:541-752-9826
Practice Address - Fax:866-905-8115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL16881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR844704002OtherREGENCE BCBSO PROV NO
OR810573161OtherCLINIC TAX ID
OR844704002OtherREGENCE BCBSO PROV NO