Healthcare Provider Details

I. General information

NPI: 1649693623
Provider Name (Legal Business Name): JAMES L BARTLEY JR. MSW, LMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 26TH ST
ORD NE
68862-1240
US

IV. Provider business mailing address

2707 L ST
ORD NE
68862-1275
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-4200
  • Fax: 308-728-5779
Mailing address:
  • Phone: 308-728-4200
  • Fax: 308-728-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: