Provider Demographics
NPI:1386237758
Name:BARTH, JOLENE JANETTE (PPC)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:JANETTE
Last Name:BARTH
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 N BUCKBOARD CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5676
Mailing Address - Country:US
Mailing Address - Phone:307-682-2034
Mailing Address - Fax:307-682-2968
Practice Address - Street 1:812 E 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4033
Practice Address - Country:US
Practice Address - Phone:307-682-2034
Practice Address - Fax:307-682-2968
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional