Provider Demographics
NPI:1053943159
Name:BARRIOS MARTINEZ, MARICELA
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:BARRIOS MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARICELA
Other - Middle Name:BARRIOS
Other - Last Name:CHAILIAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2722 COLBY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2722 COLBY AVE STE 10
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3557
Practice Address - Country:US
Practice Address - Phone:559-284-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61040112175T00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor