Provider Demographics
NPI:1902141955
Name:BARNETT, BRANDEN RICHARD (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:RICHARD
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 GRAY ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2448
Mailing Address - Country:US
Mailing Address - Phone:614-330-7118
Mailing Address - Fax:
Practice Address - Street 1:657 GRAY ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2448
Practice Address - Country:US
Practice Address - Phone:614-330-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000022101YM0800X
FLMH13320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health