Healthcare Provider Details

I. General information

NPI: 1285014589
Provider Name (Legal Business Name): DIANNE BARNES LPCC LPAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 4TH ST NW STE B
LOS RANCHOS NM
87107-6639
US

IV. Provider business mailing address

PO BOX 22005
ALBUQUERQUE NM
87154-2005
US

V. Phone/Fax

Practice location:
  • Phone: 505-492-5128
  • Fax:
Mailing address:
  • Phone: 505-492-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0156861
License Number StateNM

VIII. Authorized Official

Name: MS. DIANNE RENEE BARNES
Title or Position: OWNER/COUNSELOR
Credential: LPCC LPAT ATR-BC NCC
Phone: 505-492-5128