Provider Demographics
NPI:1851701627
Name:MODERN TREATMENT HEALTHCARE SERVICES, PLLC
Entity Type:Organization
Organization Name:MODERN TREATMENT HEALTHCARE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LPA, LPC, EDD
Authorized Official - Phone:980-643-1943
Mailing Address - Street 1:92 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8661
Mailing Address - Country:US
Mailing Address - Phone:980-643-1943
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN ST W STE 9
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690
Practice Address - Country:US
Practice Address - Phone:980-643-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC2058261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107413Medicaid