Provider Demographics
NPI:1265534606
Name:BARTLETT, ANGELA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132343
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2343
Mailing Address - Country:US
Mailing Address - Phone:281-520-7966
Mailing Address - Fax:936-873-8985
Practice Address - Street 1:25511 BUDDE RD STE 1503
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2081
Practice Address - Country:US
Practice Address - Phone:281-520-7966
Practice Address - Fax:936-873-8985
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7398349OtherAETNA
TX0008HVOtherBLUE CROSS BLUE SHIELD
TX00629PMedicare ID - Type UnspecifiedMEDICARE PART B