Provider Demographics
NPI:1881350973
Name:BARNES, JESSICA BERNICE (P-LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BERNICE
Last Name:BARNES
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1223
Mailing Address - Country:US
Mailing Address - Phone:601-319-0884
Mailing Address - Fax:
Practice Address - Street 1:2900 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2408
Practice Address - Country:US
Practice Address - Phone:601-319-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty