MEDICARE: MS. LAURIE MARCINE BARNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YM0800X	OTHER	CA	MENTAL HEALTH SPECIALIST

General Provider Information

NPI Number	:	1770647414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE MARCINE BARNES

Provider Business Mailing Address
First Line	:	9412 BIG HORN BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1101
Country	:	US
Telephone Number	:	916-879-2178
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 BIG HORN BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1101
Country	:	US
Telephone Number	:	916-879-2178
Fax Number	:	916-226-2804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	03/17/2018

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