Provider Demographics
NPI:1073409074
Name:BARKER, RUSTY (AOD)
Entity type:Individual
Prefix:
First Name:RUSTY
Middle Name:
Last Name:BARKER
Suffix:
Gender:M
Credentials:AOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 W JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8676
Mailing Address - Country:US
Mailing Address - Phone:805-556-5665
Mailing Address - Fax:
Practice Address - Street 1:3831 W JEROME AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8676
Practice Address - Country:US
Practice Address - Phone:805-556-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI38000323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)