Provider Demographics
NPI:1588106033
Name:BARDELLI, COLLEEN (MA, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BARDELLI
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BARTONS BLUFF LN APT 1101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7933
Mailing Address - Country:US
Mailing Address - Phone:512-676-8058
Mailing Address - Fax:
Practice Address - Street 1:2800 BARTONS BLUFF LN APT 1101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7933
Practice Address - Country:US
Practice Address - Phone:512-676-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81280101YM0800X
NY007682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health