Provider Demographics
NPI:1659106235
Name:BARTKO, DIANE (MA, LPC, BC-DMT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BARTKO
Suffix:
Gender:F
Credentials:MA, LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 GRAPE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2831
Mailing Address - Country:US
Mailing Address - Phone:303-941-1069
Mailing Address - Fax:
Practice Address - Street 1:777 POPLAR AVE STE 735
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1067
Practice Address - Country:US
Practice Address - Phone:303-941-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC1401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional