MEDICARE: BREANNE ALYNN BARELA PSYD

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
1	103TS0200X	School Psychologist	351897	CO
2	103TC0700X	Clinical Psychologist	PSYC.00014450	CO

General Provider Information

NPI Number	:	1306425004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNE ALYNN BARELA PSYD

Provider Business Mailing Address
First Line	:	1064 SPRUCE CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-7008
Country	:	US
Telephone Number	:	970-389-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1064 SPRUCE CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-7008
Country	:	US
Telephone Number	:	970-389-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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