Provider Demographics
NPI:1811265523
Name:BARNES, MERRY RANAE BUCKLEY (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:MERRY
Middle Name:RANAE BUCKLEY
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:DR
Other - First Name:MERRY
Other - Middle Name:RANAE
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD LP
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical