Provider Demographics
NPI:1881987386
Name:BARNES, EDNA IBEL (MA)
Entity type:Individual
Prefix:MS
First Name:EDNA
Middle Name:IBEL
Last Name:BARNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W OLYMPIC BLVD STE 1035
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3864
Mailing Address - Country:US
Mailing Address - Phone:323-538-3500
Mailing Address - Fax:
Practice Address - Street 1:1605 W OLYMPIC BLVD STE 1035
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3864
Practice Address - Country:US
Practice Address - Phone:323-538-3500
Practice Address - Fax:323-372-3712
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist