MEDICARE: JESS BARTLETT MSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184197717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS BARTLETT MSW

Provider Business Mailing Address
First Line	:	1107 E 13TH ST STE E
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-7956
Country	:	US
Telephone Number	:	918-791-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 E 13TH ST STE E
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-7956
Country	:	US
Telephone Number	:	918-791-9700
Fax Number	:

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

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/07/2019

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