Basic Information
| Provider Information | |||||||||
| NPI: | 1831634831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTHOLOMEW | ||||||||
| FirstName: | THERESA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16782 VON KARMAN AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926069928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552237123 | ||||||||
| FaxNumber: | 6193747134 | ||||||||
| Practice Location | |||||||||
| Address1: | 12465 LEWIS ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928404658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498332237 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2016 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-23985 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.