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General NPI Number Information
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NPI Number | 1720574452
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Entity Type | Individual
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Provider Name | BORIS TRENT BARTLEY II PLPC
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Gender | Male
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST STE 436
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City | SHREVEPORT
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State | LA
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Zip | 71105-2431
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Country | US
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Telephone | 318-606-4413
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Fax | 318-425-9030
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Provider Business Mailing Address
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Address Line | 4141 COURTLAND WAY
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City | BENTON
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State | LA
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Zip | 71006-9723
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Country | US
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Telephone | 318-294-7569
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10902
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License Number State | LA
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