| Bart Trentham, Pllc | |
|
4870 S Lewis Ave -180 Tuls. Tulsa OK 74105 | |
| (918) 628-7277 | |
| (918) 742-7677 |
| Full Name | Bart Trentham, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4870 S Lewis Ave -180 Tuls., Tulsa, Oklahoma |
| Authorized Official Name and Position | Barton Jay Trentham (SOLE OWNER) |
| Authorized Official Contact | 9186287277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bart Trentham, Pllc 4870 S Lewis Ave -180 Tulsa OK 74105 Ph: (918) 628-7277 | Bart Trentham, Pllc 4870 S Lewis Ave -180 Tuls. Tulsa OK 74105 Ph: (918) 628-7277 |
| NPI Number | 1881917151 |
|---|---|
| Provider Enumeration Date | 03/01/2010 |
| Last Update Date | 03/01/2010 |
| Medicare PECOS PAC ID | 5092997056 |
|---|---|
| Medicare Enrollment ID | O20110311000416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881917151 | NPI | - | NPPES |
| 100840760D | Medicaid | OK | |
| 100667880A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 763 (Oklahoma) | Primary |
| Provider Name | Bart J Trentham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336222579 PECOS PAC ID: 6800078866 Enrollment ID: I20120830000801 |
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