Healthcare Provider Details

I. General information

NPI: 1942164421
Provider Name (Legal Business Name): JON L BARTHOLOMEW MS ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WEST 1250 NORTH SUITE 3C
LOGAN UT
84341
US

IV. Provider business mailing address

85 S CENTER ST
WESTON ID
83286-5010
US

V. Phone/Fax

Practice location:
  • Phone: 435-535-1203
  • Fax:
Mailing address:
  • Phone: 208-339-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12868434-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: