Provider Demographics
NPI:1407334865
Name:BARNES, DAMIAN MITCHEL
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:MITCHEL
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SW BACK COURT PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8005
Mailing Address - Country:US
Mailing Address - Phone:503-332-6715
Mailing Address - Fax:
Practice Address - Street 1:750 SW BACK COURT PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-8005
Practice Address - Country:US
Practice Address - Phone:503-332-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst