Provider Demographics
NPI:1972647394
Name:BARKETT, BRIAN LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:BARKETT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0621
Mailing Address - Country:US
Mailing Address - Phone:740-587-1543
Mailing Address - Fax:740-587-1573
Practice Address - Street 1:941 RIVER RD
Practice Address - Street 2:STE B
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9534
Practice Address - Country:US
Practice Address - Phone:740-587-1543
Practice Address - Fax:740-587-1573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical