Provider Demographics
NPI:1689400905
Name:HALTON, BARRY MICHAEL (PSS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:MICHAEL
Last Name:HALTON
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4315
Mailing Address - Country:US
Mailing Address - Phone:541-205-3735
Mailing Address - Fax:
Practice Address - Street 1:3206 ONYX AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7279
Practice Address - Country:US
Practice Address - Phone:541-882-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111859175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist