Provider Demographics
NPI:1396050787
Name:BARTELT, ANA-LISA IE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:ANA-LISA
Middle Name:IE
Last Name:BARTELT
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BARTELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3775 WILD OATS LN
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-3059
Mailing Address - Country:US
Mailing Address - Phone:808-741-1019
Mailing Address - Fax:
Practice Address - Street 1:855 BOWSPRIT RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4529
Practice Address - Country:US
Practice Address - Phone:808-535-7600
Practice Address - Fax:808-535-7630
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA104664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health