Provider Demographics
NPI:1134366784
Name:BARNEY, LD (LADC, LADAC, SAP)
Entity type:Individual
Prefix:MR
First Name:LD
Middle Name:
Last Name:BARNEY
Suffix:
Gender:M
Credentials:LADC, LADAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DEVIZIS DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3820
Mailing Address - Country:US
Mailing Address - Phone:479-268-4823
Mailing Address - Fax:
Practice Address - Street 1:39 DEVIZIS DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3820
Practice Address - Country:US
Practice Address - Phone:479-268-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-18
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0285LOtherLADAC
OK342OtherLICENSED ALCOHOL AND DRUG COUNSELOR