MEDICARE: JASON BARTHOLOMAY MA, LMFT, LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	303671	MN
2	106H00000X	Marriage & Family Therapist	3491	MN
3	106H00000X	Marriage & Family Therapist	LF61557091	WA

General Provider Information

NPI Number	:	1376024307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON BARTHOLOMAY MA, LMFT, LADC

Provider Business Mailing Address
First Line	:	20855 KENSINGTON BLVD STE B201
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-7542
Country	:	US
Telephone Number	:	507-291-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	20855 KENSINGTON BLVD STE B201
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-7542
Country	:	US
Telephone Number	:	507-291-2662
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	01/09/2026

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