=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437449188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID L BARTHOLOMEW III LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 10/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W TEXAS AVE
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77520-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-427-4226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 WILCREST DR STE 300
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77042-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-628-3371
-----------------------------------------------------
Fax | 281-941-2559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 52113
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------