Provider Demographics
NPI:1790314227
Name:REESE, BARBARA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:KAY
Last Name:REESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:REESE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3553 ROMA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7577
Mailing Address - Country:US
Mailing Address - Phone:575-339-9222
Mailing Address - Fax:
Practice Address - Street 1:ROMA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7577
Practice Address - Country:US
Practice Address - Phone:575-339-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15774101YM0800X
NMCCMH0196521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health