Provider Demographics
NPI:1225624281
Name:BARNEY, MITCHELL RAY (LSMW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:RAY
Last Name:BARNEY
Suffix:
Gender:M
Credentials:LSMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 JENNIE LEE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6159
Mailing Address - Country:US
Mailing Address - Phone:208-520-7074
Mailing Address - Fax:
Practice Address - Street 1:1908 JENNIE LEE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6159
Practice Address - Country:US
Practice Address - Phone:208-520-7074
Practice Address - Fax:208-970-6188
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-41015104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker