Provider Demographics
NPI:1881604676
Name:BARNES, ALICIA DIANE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DIANE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:DIANE
Other - Last Name:SCHILB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5107 S BROOKS DR
Mailing Address - Street 2:UNITE A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0466
Mailing Address - Country:US
Mailing Address - Phone:573-634-4591
Mailing Address - Fax:573-634-4792
Practice Address - Street 1:204 METRO DR
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4408
Practice Address - Country:US
Practice Address - Phone:573-634-4591
Practice Address - Fax:573-634-4792
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004760101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649269622OtherBILLING NPI
MO1467597872OtherJEFF CITY NPI