Provider Demographics
NPI:1326248394
Name:BARNES, KIMBERLEE PALMER (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:PALMER
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-0034
Mailing Address - Country:US
Mailing Address - Phone:573-870-1959
Mailing Address - Fax:
Practice Address - Street 1:92 BURKE RDG
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-7198
Practice Address - Country:US
Practice Address - Phone:678-571-8738
Practice Address - Fax:706-850-0899
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002287101YM0800X
GAPSY003042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA412857094AMedicaid
GA511I680006Medicare PIN