MEDICARE: MELANIE S BARTHOLOMEW 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

General Provider Information

NPI Number	:	1982379236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE S BARTHOLOMEW LMHC

Provider Business Mailing Address
First Line	:	110 MILWAUKEE AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5663
Country	:	US
Telephone Number	:	904-312-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 MILWAUKEE AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5663
Country	:	US
Telephone Number	:	904-312-2511
Fax Number	:

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/10/2021

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