Provider Demographics
NPI:1699854844
Name:BARTEE, RUSSELL FLOYD
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:FLOYD
Last Name:BARTEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 AIRPORT FWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6667
Mailing Address - Country:US
Mailing Address - Phone:817-354-5554
Mailing Address - Fax:817-354-5556
Practice Address - Street 1:1100 AIRPORT FWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6667
Practice Address - Country:US
Practice Address - Phone:817-354-5554
Practice Address - Fax:817-354-5556
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11248101YP2500X
TX2773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist