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1720574452 NPI number — BORIS TRENT BARTLEY II PLPC

NPI Number: 1720574452
Health Care Provider/Practitioner: BORIS TRENT BARTLEY II PLPC

Information about “1720574452” NPI (BORIS TRENT BARTLEY II PLPC) exists in 1720574452 in HTML format HTML  |  1720574452 in plain Text format TXT  |  1720574452 in PDF (Portable Document Format) PDF  |  1720574452 in an XML format XML  formats.

NPI Number : 1720574452 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720574452",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BARTLEY",
    "FirstName": "BORIS",
    "MiddleName": "TRENT",
    "NamePrefix": "MR.",
    "NameSuffix": "II",
    "Credential": "PLPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4141 COURTLAND WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTON",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71006-9723",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "318-294-7569",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2924 KNIGHT ST STE 436",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHREVEPORT",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "71105-2431",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "318-606-4413",
    "PracticeLocationAddressFaxNumber": "318-425-9030",
    "EnumerationDate": "07/05/2018",
    "LastUpdateDate": "10/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "10902",
        "LicenseNumberStateCode": "LA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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