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General NPI Number Information
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NPI Number | 1225448954
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Entity Type | Organization
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Legal Business Name | NICK BARNECLO,LLC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 330 N CAMPO ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3433
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Country | US
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Telephone | 575-541-1110
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Fax | 575-541-1113
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Provider Business Mailing Address
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Address Line | 330 N CAMPO ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3433
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Country | US
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Telephone | 575-541-1110
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Fax | 575-541-1113
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. NICK BARNECLO
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Credential | PH.D.
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Telephone | 575-650-0843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1108
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License Number State | NM
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