Provider Demographics
NPI:1891762191
Name:BARNUM, DAVID D'OWEN (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D'OWEN
Last Name:BARNUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 W. 6TH ST., SUITE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-830-8299
Mailing Address - Fax:785-749-2581
Practice Address - Street 1:2619 W. 6TH ST., SUITE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:913-682-4664
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100117700AMedicaid
KS100117700AMedicaid
KSP30342Medicare UPIN