Provider Demographics
NPI:1326563651
Name:BARRELLA, KIMBERLEE ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ANN
Last Name:BARRELLA
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 1:960 GRAHAM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1155
Mailing Address - Country:US
Mailing Address - Phone:234-281-2089
Mailing Address - Fax:
Practice Address - Street 1:960 GRAHAM RD STE 3
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1155
Practice Address - Country:US
Practice Address - Phone:234-281-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2002001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271635Medicaid