Provider Demographics
NPI:1134259823
Name:BARNES, OLLIE GARFIELD III (EDD)
Entity type:Individual
Prefix:DR
First Name:OLLIE
Middle Name:GARFIELD
Last Name:BARNES
Suffix:III
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 WINTER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4242
Mailing Address - Country:US
Mailing Address - Phone:269-323-7995
Mailing Address - Fax:269-323-2282
Practice Address - Street 1:576 ROMENCE RD
Practice Address - Street 2:SUITE 222
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3472
Practice Address - Country:US
Practice Address - Phone:269-207-7373
Practice Address - Fax:269-323-2282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006696103TC0700X
MI6401004942103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling