Provider Demographics
NPI:1982801437
Name:BARKSDALE, TIM (MA)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2430
Mailing Address - Country:US
Mailing Address - Phone:215-868-6766
Mailing Address - Fax:
Practice Address - Street 1:606 MASON AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2430
Practice Address - Country:US
Practice Address - Phone:215-868-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor