Provider Demographics
NPI:1942232459
Name:BARTOL, GEOFFREY H (PHD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:H
Last Name:BARTOL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NW VICKSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1228
Mailing Address - Country:US
Mailing Address - Phone:541-389-7631
Mailing Address - Fax:
Practice Address - Street 1:26 NW IRVING AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2012
Practice Address - Country:US
Practice Address - Phone:541-385-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical