Provider Demographics
NPI:1740355742
Name:SMITH, BARBARA ANNE (MA, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANNE
Other - Last Name:YEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 51692
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1692
Mailing Address - Country:US
Mailing Address - Phone:505-450-6705
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 103
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1040
Practice Address - Country:US
Practice Address - Phone:505-450-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06882OtherLOVELACE HEALTH PLAN