Provider Demographics
NPI:1477766095
Name:BARTLETT, CRISTY S (LPC)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:S
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8632
Mailing Address - Country:US
Mailing Address - Phone:479-879-0094
Mailing Address - Fax:888-547-7660
Practice Address - Street 1:3331 EAST HERITAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-7273
Practice Address - Country:US
Practice Address - Phone:479-879-0094
Practice Address - Fax:888-547-7660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1306058101Y00000X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator