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General NPI Number Information
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NPI Number | 1699322248
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Entity Type | Individual
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Provider Name | DESIRRAE LOUANN BARNETT LMHC
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Gender |
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 224 S ARTHUR AVE STE 2
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City | POCATELLO
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State | ID
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Zip | 83204-3202
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Country | US
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Telephone | 208-242-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 2842 38TH ST APT 1R
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City | ASTORIA
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State | NY
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Zip | 11103-1451
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Country | US
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Telephone | 470-419-0638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 014754
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-7344
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License Number State | ID
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