Provider Demographics
NPI:1366603292
Name:BARTRAM, NICOLA ELIZABETH (LPC)
Entity type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:ELIZABETH
Last Name:BARTRAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W SAGEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6915
Mailing Address - Country:US
Mailing Address - Phone:480-529-6185
Mailing Address - Fax:
Practice Address - Street 1:3260 N HAYDEN RD
Practice Address - Street 2:#101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6649
Practice Address - Country:US
Practice Address - Phone:480-529-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health