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NPI Code Detail

MEDICARE: NICK BARNECLO,LLC

MEDICARE: NICK BARNECLO,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist1108NM

General Provider Information

NPI Number : 1225448954
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICK BARNECLO,LLC
Provider Business Mailing Address
First Line : 330 N CAMPO ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3433
Country : US
Telephone Number : 575-541-1110
Fax Number : 575-541-1113
Provider Business Practice Location Address
First Line : 330 N CAMPO ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3433
Country : US
Telephone Number : 575-541-1110
Fax Number : 575-541-1113
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : DR. NICK BARNECLO
Credential : PH.D.
Telephone Number : 575-650-0843
Provider Enumeration Date : 05/02/2014
Last Update Date : 05/02/2014

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