Provider Demographics
NPI:1144390410
Name:BARTLEY, DENISE FRAZIER (PHD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:FRAZIER
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 43RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-3031
Mailing Address - Country:US
Mailing Address - Phone:806-239-4379
Mailing Address - Fax:
Practice Address - Street 1:4630 50TH ST
Practice Address - Street 2:SUITE 509
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3521
Practice Address - Country:US
Practice Address - Phone:806-771-8808
Practice Address - Fax:806-771-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86984AOtherBLUE CROSS BLUE SHIELD