Provider Demographics
NPI:1003364605
Name:BARNES, LISA (MA PSY, LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:MA PSY, LMHC
Other - Prefix:
Other - First Name:JAHNAVI
Other - Middle Name:LISA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA PSY, LMHC
Mailing Address - Street 1:2367 RUTA CORTA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6907
Mailing Address - Country:US
Mailing Address - Phone:206-218-4498
Mailing Address - Fax:
Practice Address - Street 1:13 OLD AGUA FRIA RD E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-5970
Practice Address - Country:US
Practice Address - Phone:505-988-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0182201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health