Provider Demographics
NPI:1477194132
Name:BARNES, MACY L
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:L
Last Name:BARNES
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 1:1551 N VIRGINIA ST UNIT 612
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1746
Mailing Address - Country:US
Mailing Address - Phone:925-216-7062
Mailing Address - Fax:
Practice Address - Street 1:2125 GREEN VISTA DR STE 106
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8515
Practice Address - Country:US
Practice Address - Phone:775-622-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist