MEDICARE: REBECCA BARTLE

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	76759	TX

General Provider Information

NPI Number	:	1154978708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BARTLE

Provider Business Mailing Address
First Line	:	PO BOX 63722
Second Line	:
City	:	PIPE CREEK
State	:	TX
Zip	:	78063-3722
Country	:	US
Telephone Number	:	315-486-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 CREEKSIDE PARK RD
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6109
Country	:	US
Telephone Number	:	315-486-1883
Fax Number	:

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

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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Directions to “ REBECCA BARTLE ” Practice Location

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