Provider Demographics
NPI:1689875858
Name:BARTOLE, CANDY L (LMFT, CEDS)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:L
Last Name:BARTOLE
Suffix:
Gender:F
Credentials:LMFT, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 S. VICTORIA AVE.
Mailing Address - Street 2:STE 250
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-512-2542
Mailing Address - Fax:805-659-3770
Practice Address - Street 1:1752 S. VICTORIA AVE
Practice Address - Street 2:STE 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-512-2542
Practice Address - Fax:805-659-3770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist