Provider Demographics
NPI:1871606327
Name:BARRUS, KIM B (PHD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:BARRUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30495 CANWOOD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4331
Mailing Address - Country:US
Mailing Address - Phone:818-707-7366
Mailing Address - Fax:818-707-2672
Practice Address - Street 1:30495 CANWOOD ST STE 101
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4331
Practice Address - Country:US
Practice Address - Phone:818-707-7366
Practice Address - Fax:818-707-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6155Medicare PIN
CACP6155Medicare ID - Type UnspecifiedPSYCHOLOGIST