Provider Demographics
NPI:1376184945
Name:BARR, IVEY MICHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:IVEY
Middle Name:MICHELLE
Last Name:BARR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6000
Mailing Address - Country:US
Mailing Address - Phone:719-493-7086
Mailing Address - Fax:
Practice Address - Street 1:408 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6000
Practice Address - Country:US
Practice Address - Phone:719-493-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician