Provider Demographics
NPI:1225055296
Name:BARTA, JONNA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONNA
Middle Name:LEE
Last Name:BARTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MCDERMOTT DR # 109
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2751
Mailing Address - Country:US
Mailing Address - Phone:214-629-6986
Mailing Address - Fax:214-221-0683
Practice Address - Street 1:101 W MCDERMOTT DR STE 109
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2751
Practice Address - Country:US
Practice Address - Phone:214-629-6986
Practice Address - Fax:214-221-0683
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-1280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0092LVOtherBCBS
TX170019703Medicaid
TX610956Medicare PIN
TX170019703Medicaid