MEDICARE: MS. BETHANY ANN BARTA L. C. S. W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6135	CO
2	1041C0700X	Clinical Social Worker	992831	CO

General Provider Information

NPI Number	:	1609095025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETHANY ANN BARTA L. C. S. W.

Provider Business Mailing Address
First Line	:	1735 YORK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1212
Country	:	US
Telephone Number	:	303-246-3219
Fax Number	:	303-256-9441

Provider Business Practice Location Address
First Line	:	1735 YORK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1212
Country	:	US
Telephone Number	:	303-246-3219
Fax Number	:	303-256-9441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/06/2008

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