Provider Demographics
NPI:1811407596
Name:BARNES, TINA PATRICE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:PATRICE
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 1:11120 GRAVELLY LAKE DR SW STE 7
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1351
Mailing Address - Country:US
Mailing Address - Phone:360-229-2999
Mailing Address - Fax:
Practice Address - Street 1:11120 GRAVELLY LAKE DR SW STE 7
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1351
Practice Address - Country:US
Practice Address - Phone:360-229-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60771271101YM0800X
WAP00153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health