Provider Demographics
NPI:1649954298
Name:BARNES, JERRON DEVANTE
Entity type:Individual
Prefix:
First Name:JERRON
Middle Name:DEVANTE
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-4002
Mailing Address - Country:US
Mailing Address - Phone:575-496-1947
Mailing Address - Fax:
Practice Address - Street 1:2072 S WEST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-4002
Practice Address - Country:US
Practice Address - Phone:575-496-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst