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General NPI Number Information
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NPI Number | 1942164421
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Entity Type | Individual
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Provider Name | JON L BARTHOLOMEW MS ACMHC
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Gender | Male
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 40 WEST 1250 NORTH SUITE 3C
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City | LOGAN
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State | UT
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Zip | 84341
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Country | US
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Telephone | 435-535-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 85 S CENTER ST
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City | WESTON
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State | ID
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Zip | 83286-5010
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Country | US
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Telephone | 208-339-3902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12868434-6009
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License Number State | UT
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