Healthcare Provider Details

I. General information

NPI: 1578862611
Provider Name (Legal Business Name): GREGORY BARTELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DOUSMAN ST
GREEN BAY WI
54303-3211
US

IV. Provider business mailing address

1701 DOUSMAN ST
GREEN BAY WI
54303-3211
US

V. Phone/Fax

Practice location:
  • Phone: 920-498-8600
  • Fax:
Mailing address:
  • Phone: 920-562-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4914-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4914-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: