Provider Demographics
NPI:1295763233
Name:BARNHILL, LAURENCE R (PHD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:R
Last Name:BARNHILL
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 1:205 N COLLEGE AVE
Mailing Address - Street 2:SUITE 614
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3950
Mailing Address - Country:US
Mailing Address - Phone:812-334-2229
Mailing Address - Fax:812-339-9068
Practice Address - Street 1:205 N COLLEGE AVE
Practice Address - Street 2:SUITE 614
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3950
Practice Address - Country:US
Practice Address - Phone:812-334-2229
Practice Address - Fax:812-339-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010266A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN545970Medicare ID - Type UnspecifiedPSYCHOLOGIST