Provider Demographics
NPI:1104968924
Name:BARRETT, RENEA LEE (LAC CH)
Entity type:Individual
Prefix:MS
First Name:RENEA
Middle Name:LEE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LAC CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 E SEMINOLE ST STE O
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2454
Mailing Address - Country:US
Mailing Address - Phone:417-569-7913
Mailing Address - Fax:417-882-7447
Practice Address - Street 1:1675 E SEMINOLE ST STE O
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2454
Practice Address - Country:US
Practice Address - Phone:417-569-7913
Practice Address - Fax:417-882-7447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist