Provider Demographics
NPI:1477841617
Name:BARNHOUSE, MARK ALLEN (MA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:BARNHOUSE
Suffix:
Gender:M
Credentials:MA
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Mailing Address - Street 1:901 EASTERN AVE NE
Mailing Address - Street 2:BETHANY CHRISTIAN SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-0294
Mailing Address - Country:US
Mailing Address - Phone:616-224-7569
Mailing Address - Fax:616-224-7581
Practice Address - Street 1:901 EASTERN AVE NE
Practice Address - Street 2:BETHANY CHRISTIAN SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49501-0294
Practice Address - Country:US
Practice Address - Phone:616-224-7569
Practice Address - Fax:616-224-7581
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI6301005098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301005098OtherSTATE OF MICHIGAN - BOARD OF PSYCHOLOGY LICENSE