Healthcare Provider Details

I. General information

NPI: 1306425004
Provider Name (Legal Business Name): BREANNE ALYNN BARELA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

7909 E 25TH PL
DENVER CO
80238-2486
US

V. Phone/Fax

Practice location:
  • Phone: 970-389-2888
  • Fax:
Mailing address:
  • Phone: 970-389-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number351897
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0005865
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: