Provider Demographics
NPI:1689854119
Name:BARTSCH, NADINE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:L
Last Name:BARTSCH
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 1:255 N EGRET BAY BLVD
Mailing Address - Street 2:APT 4112
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6533
Mailing Address - Country:US
Mailing Address - Phone:832-932-5397
Mailing Address - Fax:
Practice Address - Street 1:255 N EGRET BAY BLVD
Practice Address - Street 2:APT 4112
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6533
Practice Address - Country:US
Practice Address - Phone:832-932-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192667701Medicaid
TX8F7034Medicare PIN