Healthcare Provider Details

I. General information

NPI: 1861706095
Provider Name (Legal Business Name): PAULA BARTHELMESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N MAIN ST
MERIDIAN ID
83642-2301
US

IV. Provider business mailing address

1031 W SANETTA ST
NAMPA ID
83651-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-600-2184
  • Fax: 833-258-9488
Mailing address:
  • Phone: 208-466-7443
  • Fax: 208-466-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29380
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: