Basic Information
Provider Information
NPI: 1548453608
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARELA
FirstName: JOHN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: COUNSELOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1124 BAKER ST
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933054322
CountryCode: US
TelephoneNumber: 6613279376
FaxNumber: 6613277649
Practice Location
Address1: 1124 BAKER ST
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933054322
CountryCode: US
TelephoneNumber: 6613279376
FaxNumber: 6613277649
Other Information
ProviderEnumerationDate: 08/22/2007
LastUpdateDate: 02/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400XA021371215CAY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


Home