Provider Demographics
NPI:1255080107
Name:BARELA, EDIE (LMHC)
Entity type:Individual
Prefix:
First Name:EDIE
Middle Name:
Last Name:BARELA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 DEBRA ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5394
Mailing Address - Country:US
Mailing Address - Phone:157-576-0532
Mailing Address - Fax:
Practice Address - Street 1:1912 DEBRA ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5394
Practice Address - Country:US
Practice Address - Phone:157-576-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0219911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health