MEDICARE: DR. MICHAEL TODD BARTA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3099	CO

General Provider Information

NPI Number	:	1083730121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TODD BARTA LPC

Provider Business Mailing Address
First Line	:	3715 BIRCHWOOD DR APT 14
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-1420
Country	:	US
Telephone Number	:	303-938-1242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 PEARL ST STE 318
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5130
Country	:	US
Telephone Number	:	720-201-0656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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