Provider Demographics
NPI:1699400820
Name:BARNES, BETHANY GAIL
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:GAIL
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 BORREGO TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3223
Mailing Address - Country:US
Mailing Address - Phone:760-905-3767
Mailing Address - Fax:
Practice Address - Street 1:7495 BORREGO TRL
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3223
Practice Address - Country:US
Practice Address - Phone:760-905-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician