Provider Demographics
NPI:1801304860
Name:BARTHOL, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARTHOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22438 LANSE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1369
Mailing Address - Country:US
Mailing Address - Phone:586-360-7252
Mailing Address - Fax:
Practice Address - Street 1:22438 LANSE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1369
Practice Address - Country:US
Practice Address - Phone:586-360-7252
Practice Address - Fax:586-360-7252
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14191895Medicaid
6401014769OtherSTATE OF MI LPC