Provider Demographics
NPI:1568985760
Name:BARNES, BOBBY CAIN
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:CAIN
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 1:2832 DUBLIN BLVD APT 236
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5808
Mailing Address - Country:US
Mailing Address - Phone:731-514-0474
Mailing Address - Fax:
Practice Address - Street 1:312 WILCOX ST STE 201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2481
Practice Address - Country:US
Practice Address - Phone:720-512-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO471303775103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst