MEDICARE: BARTOLOME E COLOM LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH11368	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043569379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARTOLOME E COLOM LMHC

Provider Business Mailing Address
First Line	:	1292 BRAMLEY LN
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0850
Country	:	US
Telephone Number	:	407-782-5525
Fax Number	:	386-943-9976

Provider Business Practice Location Address
First Line	:	452 OSCEOLA ST
Second Line	:	SUITE 101
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-7817
Country	:	US
Telephone Number	:	407-782-5525
Fax Number	:	386-943-9976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	10/03/2012

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Directions to “ BARTOLOME E COLOM LMHC” Practice Location

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