Provider Demographics
NPI:1417359126
Name:BARNES, TERESA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E LE MARCHE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3217
Mailing Address - Country:US
Mailing Address - Phone:602-999-1396
Mailing Address - Fax:
Practice Address - Street 1:1520 E LE MARCHE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3217
Practice Address - Country:US
Practice Address - Phone:602-999-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst