Provider Demographics
NPI:1730564485
Name:BARTON, RAINISHA LA VERNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:RAINISHA
Middle Name:LA VERNE
Last Name:BARTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:RAINISHA
Other - Middle Name:LA VERNE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6777 CAMP BOWIE BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7157
Mailing Address - Country:US
Mailing Address - Phone:682-703-1311
Mailing Address - Fax:817-887-1694
Practice Address - Street 1:6777 CAMP BOWIE BLVD STE 229
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7157
Practice Address - Country:US
Practice Address - Phone:682-703-1311
Practice Address - Fax:817-887-1694
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70918101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347341502Medicaid
TX347341501Medicaid