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General NPI Number Information
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NPI Number | 1417105057
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Entity Type | Organization
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Legal Business Name | LS BARTLEY, LLC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 1420 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73703-5751
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Country | US
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Telephone | 580-234-9233
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Fax | 580-234-9256
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Provider Business Mailing Address
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Address Line | 1420 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73703-5751
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Country | US
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Telephone | 580-234-9233
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Fax | 580-234-9256
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORI LYNN BARTLEY
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Credential | MCP, LPC
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Telephone | 580-234-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3576
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License Number State | OK
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