Provider Demographics
NPI:1831731215
Name:BARNES, JODIE LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:BARNES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SOUTH 4TH EAST
Mailing Address - Street 2:BOX 1
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1604
Mailing Address - Country:US
Mailing Address - Phone:208-451-7180
Mailing Address - Fax:866-923-0022
Practice Address - Street 1:655 SOUTH 4TH EAST
Practice Address - Street 2:STE 100
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1604
Practice Address - Country:US
Practice Address - Phone:208-451-7180
Practice Address - Fax:866-923-0022
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-8485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional