Provider Demographics
NPI:1841540770
Name:BARTLETT, EMMA JOAN (LMFT)
Entity type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:JOAN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E AZTEC AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4803
Mailing Address - Country:US
Mailing Address - Phone:505-863-3828
Mailing Address - Fax:505-863-6612
Practice Address - Street 1:2025 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-3828
Practice Address - Fax:505-863-6612
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF0208071106H00000X
NMCAD0199961101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48123404Medicaid