Provider Demographics
NPI:1053180059
Name:BARNHOUSE, JACKLIN DIANE (RBT)
Entity type:Individual
Prefix:
First Name:JACKLIN
Middle Name:DIANE
Last Name:BARNHOUSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:123 W MORGAN ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:KNIGHTSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46148-9418
Mailing Address - Country:US
Mailing Address - Phone:804-481-6447
Mailing Address - Fax:
Practice Address - Street 1:7375 W US 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8950
Practice Address - Country:US
Practice Address - Phone:888-877-7111
Practice Address - Fax:317-978-3478
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-164868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician