Provider Demographics
NPI:1619365616
Name:BARNES, CHARLES BRENTON
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRENTON
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 1:2400 GENERAL PERSHING BLVD
Mailing Address - Street 2:APT 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6400
Mailing Address - Country:US
Mailing Address - Phone:405-503-9694
Mailing Address - Fax:
Practice Address - Street 1:2400 GENERAL PERSHING BLVD
Practice Address - Street 2:APT 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6400
Practice Address - Country:US
Practice Address - Phone:405-503-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor