Provider Demographics
NPI:1902079163
Name:BARNES, MIKI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIKI
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-0838
Mailing Address - Country:US
Mailing Address - Phone:503-319-3088
Mailing Address - Fax:
Practice Address - Street 1:9860 SW HALL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8896
Practice Address - Country:US
Practice Address - Phone:503-319-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical