Healthcare Provider Details

I. General information

NPI: 1881310399
Provider Name (Legal Business Name): XICLALY JAILENE BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BETTY CT
MCKINLEYVILLE CA
95519-4405
US

IV. Provider business mailing address

1560 BETTY CT
MCKINLEYVILLE CA
95519-4405
US

V. Phone/Fax

Practice location:
  • Phone: 707-296-1865
  • Fax:
Mailing address:
  • Phone: 707-296-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: