Provider Demographics
NPI:1033720057
Name:BARTLETT, RACHELLE A (MS, PLMHC)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:A
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MS, PLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4735
Mailing Address - Country:US
Mailing Address - Phone:531-222-0500
Mailing Address - Fax:
Practice Address - Street 1:803 3RD AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-4101
Practice Address - Country:US
Practice Address - Phone:712-352-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health