Provider Demographics
NPI:1114135225
Name:BARTLEY-SMITH, CAROLYN SUE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:BARTLEY-SMITH
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 E MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-3165
Mailing Address - Country:US
Mailing Address - Phone:812-333-9800
Mailing Address - Fax:
Practice Address - Street 1:4629 E MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-3165
Practice Address - Country:US
Practice Address - Phone:812-333-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041184A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling