Provider Demographics
NPI:1306425004
Name:BARELA, BREANNE ALYNN (PSYD)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:ALYNN
Last Name:BARELA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7008
Mailing Address - Country:US
Mailing Address - Phone:970-389-2888
Mailing Address - Fax:
Practice Address - Street 1:1064 SPRUCE CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7008
Practice Address - Country:US
Practice Address - Phone:970-389-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO351897103TS0200X
COPSYC.00014450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool