Provider Demographics
NPI:1225448954
Name:NICK BARNECLO,LLC
Entity Type:Organization
Organization Name:NICK BARNECLO,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNECLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-650-0843
Mailing Address - Street 1:330 N CAMPO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3433
Mailing Address - Country:US
Mailing Address - Phone:575-541-1110
Mailing Address - Fax:575-541-1113
Practice Address - Street 1:330 N CAMPO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3433
Practice Address - Country:US
Practice Address - Phone:575-541-1110
Practice Address - Fax:575-541-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1108103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty