Provider Demographics
NPI:1780313221
Name:BARNES, IAN (LCSW)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N CENTRAL AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1217
Mailing Address - Country:US
Mailing Address - Phone:602-376-3353
Mailing Address - Fax:
Practice Address - Street 1:9051 W KELTON LN STE 13
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3533
Practice Address - Country:US
Practice Address - Phone:623-815-5700
Practice Address - Fax:623-815-5759
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-18464OtherSTATE LICENSE