Provider Demographics
NPI:1245242627
Name:BARTLEY, JOHN C (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BARTLEY
Suffix:
Gender:M
Credentials:LCSW
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 1298
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77501-1298
Mailing Address - Country:US
Mailing Address - Phone:832-672-6318
Mailing Address - Fax:832-672-6319
Practice Address - Street 1:4001 PRESTON AVE
Practice Address - Street 2:STE 145
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2062
Practice Address - Country:US
Practice Address - Phone:832-672-6318
Practice Address - Fax:832-672-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119631302Medicaid
TX8798B9Medicare ID - Type Unspecified