Provider Demographics
NPI:1174121172
Name:BARNES, TYRONE B (MPSY)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:B
Last Name:BARNES
Suffix:
Gender:M
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 N WITTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-2123
Mailing Address - Country:US
Mailing Address - Phone:317-363-9467
Mailing Address - Fax:
Practice Address - Street 1:3805 N WITTFIELD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2123
Practice Address - Country:US
Practice Address - Phone:317-363-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty