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General NPI Number Information
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NPI Number | 1235479817
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Entity Type | Individual
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Provider Name | IRENA BARTNICK MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 1585 WOODLAKE DR
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-5706
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Country | US
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Telephone | 314-583-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 6124 CHANTILLY BND
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City | WATERLOO
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State | IL
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Zip | 62298-2130
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Country | US
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Telephone | 314-583-2321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2011004955
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2011004955
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License Number State |
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