Provider Demographics
NPI:1104991223
Name:BARTLETT, CLINTON E (LPC)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:E
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 E OASIS ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-9742
Mailing Address - Country:US
Mailing Address - Phone:602-751-7414
Mailing Address - Fax:602-926-2335
Practice Address - Street 1:4300 N MILLER RD.,
Practice Address - Street 2:SUITE E-116-07
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:602-751-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health