Basic Information
Provider Information
NPI: 1003140708
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTEL
FirstName: KEELY
MiddleName: F
NamePrefix: MRS.
NameSuffix:  
Credential: L.M.S.W.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 413 BEAL ST
Address2:  
City: NORTHVILLE
State: MI
PostalCode: 481671656
CountryCode: US
TelephoneNumber: 2487670241
FaxNumber:  
Practice Location
Address1: 413 BEAL ST
Address2:  
City: NORTHVILLE
State: MI
PostalCode: 481671656
CountryCode: US
TelephoneNumber: 2487670241
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/28/2009
LastUpdateDate: 09/28/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XL1294567MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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