Provider Demographics
NPI:1588003974
Name:BARNES, STACIA ANN (LPCC)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:ANN
Last Name:BARNES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 NICHOLS LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9509
Mailing Address - Country:US
Mailing Address - Phone:740-973-9247
Mailing Address - Fax:
Practice Address - Street 1:9734 JUG ST NW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8691
Practice Address - Country:US
Practice Address - Phone:740-924-7543
Practice Address - Fax:740-924-2002
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2807341Medicaid