Provider Demographics
NPI:1235512328
Name:BARNHART, KYRA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:BARNHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3214 W MCGRAW ST
Mailing Address - Street 2:STE 212
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3239
Mailing Address - Country:US
Mailing Address - Phone:206-453-4882
Mailing Address - Fax:206-453-5094
Practice Address - Street 1:900 PACIFIC AVE STE 130
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4188
Practice Address - Country:US
Practice Address - Phone:425-258-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60777628103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty