Provider Demographics
NPI:1548409246
Name:BARTON, OLIVER JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:JOHN
Last Name:BARTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W HAVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3831
Mailing Address - Country:US
Mailing Address - Phone:605-996-9686
Mailing Address - Fax:605-996-1624
Practice Address - Street 1:910 W HAVENS AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3831
Practice Address - Country:US
Practice Address - Phone:605-996-9686
Practice Address - Fax:605-996-1624
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDPENDING103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200110Medicaid