Eran Jax Barker, SUDRC 12517

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1255760617 Issued in CA

Practice address

484 Main St
Diamond Springs, CA 95619-9100

Phone

(916) 502-6239

NPI assigned

May 25, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1790276731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "484 MAIN ST",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 MAIN ST",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199100",
            "telephone_number": "916-502-6239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "484 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Diamond Springs",
            "state": "CA",
            "postal_code": "95619",
            "country_code": "US",
            "telephone_number": "916-502-6239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARKER",
        "first_name": "ERAN",
        "middle_name": "JAX",
        "credential": "SUDRC 12517",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-25",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "1255760617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nakisha L Bailey, MFT-1
• Michelle Corinne Baird, AMFT
• Eric Balme
• Elizabeth Bane
• James Barentt Jr.
• Taylor Barnette
• Matthew Anthony Barragan
• Haylee Barrentine, LCSW
• Camie Louise Bernal
• Margaret Teresa Bilyeu

• Addiction (Substance Use Disorder) Counselor in Diamond Springs, CA
• Providers in Diamond Springs, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.