Healthcare Provider Details

I. General information

NPI: 1639321490
Provider Name (Legal Business Name): DUSTIN E BARTLEY LMHP, LADC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S 59TH ST STE 104
LINCOLN NE
68516-2386
US

IV. Provider business mailing address

3001 FLETCHER AVE APT 153
LINCOLN NE
68504-1031
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-0595
  • Fax: 402-484-6306
Mailing address:
  • Phone: 402-450-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3511
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number885
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: