Provider Demographics
NPI:1154081461
Name:BARNES, BRALIN LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRALIN
Middle Name:LEE
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRALIN
Other - Middle Name:LEE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3525 S NATIONAL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7315
Mailing Address - Country:US
Mailing Address - Phone:417-269-6891
Mailing Address - Fax:
Practice Address - Street 1:3525 S NATIONAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7315
Practice Address - Country:US
Practice Address - Phone:417-269-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021048476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist