Healthcare Provider Details

I. General information

NPI: 1609368976
Provider Name (Legal Business Name): AVERY LEIGH BARNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

524 MISSION AVE NE
ALBUQUERQUE NM
87107-4906
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2839
  • Fax: 505-295-2559
Mailing address:
  • Phone: 505-440-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20240817
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: