Provider Demographics
NPI:1750140299
Name:BARKER, ETHAN GREGORY
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:GREGORY
Last Name:BARKER
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 1:611 N BRAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3240
Mailing Address - Country:US
Mailing Address - Phone:181-826-1246
Mailing Address - Fax:
Practice Address - Street 1:611 N BRAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3240
Practice Address - Country:US
Practice Address - Phone:818-261-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician