Provider Demographics
NPI:1558645424
Name:BARNES, CLARISSA SUE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:SUE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3600
Mailing Address - Country:US
Mailing Address - Phone:618-457-0371
Mailing Address - Fax:618-529-1248
Practice Address - Street 1:1245 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3600
Practice Address - Country:US
Practice Address - Phone:618-457-0371
Practice Address - Fax:618-529-1248
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst