Provider Demographics
NPI:1881917151
Name:BART TRENTHAM, PLLC
Entity type:Organization
Organization Name:BART TRENTHAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:TRENTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-628-7277
Mailing Address - Street 1:4870 S LEWIS AVE -180
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-628-7277
Mailing Address - Fax:918-742-7677
Practice Address - Street 1:4870 S LEWIS AVE -180 TULS.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105
Practice Address - Country:US
Practice Address - Phone:918-628-7277
Practice Address - Fax:918-742-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100840760DMedicaid
OK100667880AMedicaid