Provider Demographics
NPI:1023218039
Name:BARTLETT, RICHARD DALE (LCPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:LCPC
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 547
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-0547
Mailing Address - Country:US
Mailing Address - Phone:406-257-5046
Mailing Address - Fax:406-257-5092
Practice Address - Street 1:234 2ND ST W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4412
Practice Address - Country:US
Practice Address - Phone:406-257-5046
Practice Address - Fax:406-257-5092
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1023218039Medicaid