MEDICARE: SAMUEL J JOLMAN LPC

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	101YP2500X	Professional Counselor	5443	CO

General Provider Information

NPI Number	:	1114276102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL J JOLMAN LPC

Provider Business Mailing Address
First Line	:	614 N NEVADA AVE
Second Line	:	SUITE 202
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-5021
Country	:	US
Telephone Number	:	719-447-7446
Fax Number	:	888-447-9272

Provider Business Practice Location Address
First Line	:	614 N NEVADA AVE
Second Line	:	SUITE 202
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-5021
Country	:	US
Telephone Number	:	719-447-7446
Fax Number	:	888-447-9272

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

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/12/2012

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