Provider Demographics
NPI:1831425537
Name:KATHY D. BARNETT, PHD. LLC
Entity type:Organization
Organization Name:KATHY D. BARNETT, PHD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-243-2273
Mailing Address - Street 1:PO BOX 17661
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-0661
Mailing Address - Country:US
Mailing Address - Phone:801-243-2273
Mailing Address - Fax:
Practice Address - Street 1:2040 MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-272-5083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212620-2501261QM0855X, 3104A0625X, 3104A0630X, 311500000X, 311ZA0620X, 314000000X, 261QM0850X
UT2126202501261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1710151592OtherPERSONAL NPI