Provider Demographics
NPI:1245911940
Name:THE HARTLEY CLINIC
Entity type:Organization
Organization Name:THE HARTLEY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-826-6383
Mailing Address - Street 1:3400 BISSONNET ST STE 270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2192
Mailing Address - Country:US
Mailing Address - Phone:713-913-3585
Mailing Address - Fax:
Practice Address - Street 1:3400 BISSONNET ST STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2192
Practice Address - Country:US
Practice Address - Phone:713-913-3585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY322911OtherOFFICE OF THE PROFESSIONS