Provider Demographics
NPI:1720739600
Name:BARNES, MATTHEW GEORGE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GEORGE
Last Name:BARNES
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2302
Mailing Address - Country:US
Mailing Address - Phone:502-689-8147
Mailing Address - Fax:
Practice Address - Street 1:25 BEECH DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2302
Practice Address - Country:US
Practice Address - Phone:502-689-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00981103K00000X
KY268643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
00981OtherCERTIFIED OHIO BEHAVIOR ANALYST (COBA)
KY268643OtherLICENSED BEHAVIOR ANALYST (KY)