Provider Demographics
NPI:1255841599
Name:BARTON, LANELL RENEE AMANDA (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:LANELL RENEE
Middle Name:AMANDA
Last Name:BARTON
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1522
Mailing Address - Country:US
Mailing Address - Phone:417-349-0673
Mailing Address - Fax:
Practice Address - Street 1:353 E 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4423
Practice Address - Country:US
Practice Address - Phone:870-701-5141
Practice Address - Fax:870-701-5177
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10095C1041C0700X
104100000X
MO20200080971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker