Provider Demographics
NPI:1972032068
Name:BARRACLOUGH, JENNA LEIGH (BS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:BARRACLOUGH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:GROOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:15000 CACTUS ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3802
Mailing Address - Country:US
Mailing Address - Phone:760-680-3046
Mailing Address - Fax:
Practice Address - Street 1:11776 MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1622
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)