Provider Demographics
NPI:1093395816
Name:BARNES, MICHELLE DESIREE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DESIREE
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7377 LINDSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4024
Mailing Address - Country:US
Mailing Address - Phone:562-201-8437
Mailing Address - Fax:
Practice Address - Street 1:7377 LINDSEY AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4024
Practice Address - Country:US
Practice Address - Phone:562-201-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker