Provider Demographics
NPI:1154486595
Name:BARTLETT, ALICE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18253 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3706
Mailing Address - Country:US
Mailing Address - Phone:954-435-8496
Mailing Address - Fax:954-435-5263
Practice Address - Street 1:18253 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3706
Practice Address - Country:US
Practice Address - Phone:954-435-8496
Practice Address - Fax:954-435-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL098995OtherVALUE OPTIONS FLORIDA
FLZ2532OtherBLUE CROSS BLUE SHIELD
FL17645408OtherUNITED HEALTHCARE