Provider Demographics
NPI:1306185087
Name:BARTLEY, TRACI DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:DENISE
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5859
Mailing Address - Country:US
Mailing Address - Phone:405-340-1621
Mailing Address - Fax:
Practice Address - Street 1:14101 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5859
Practice Address - Country:US
Practice Address - Phone:405-340-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical