Provider Demographics
NPI:1366627465
Name:HARTLEY, BOB (LMFT)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 REDWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1310
Mailing Address - Country:US
Mailing Address - Phone:580-585-2325
Mailing Address - Fax:
Practice Address - Street 1:2305 REDWOOD LANE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1310
Practice Address - Country:US
Practice Address - Phone:580-585-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist