Provider Demographics
NPI:1477090272
Name:BARTELS, CAROL (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BARTELS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:LAUDERDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3950 LONG BEACH BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5411
Mailing Address - Country:US
Mailing Address - Phone:562-548-8999
Mailing Address - Fax:
Practice Address - Street 1:3950 LONG BEACH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-548-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC85176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist