MEDICARE: MR. JON L BARTHOLOMEW MS ACMHC

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	12868434-6009	UT

General Provider Information

NPI Number	:	1942164421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON L BARTHOLOMEW MS ACMHC

Provider Business Mailing Address
First Line	:	85 S CENTER ST
Second Line	:
City	:	WESTON
State	:	ID
Zip	:	83286-5010
Country	:	US
Telephone Number	:	208-339-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 WEST 1250 NORTH
Second Line	:	SUITE 3C
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-535-1203
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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