Provider Demographics
NPI:1043569379
Name:COLOM, BARTOLOME E (LMHC)
Entity Type:Individual
Prefix:
First Name:BARTOLOME
Middle Name:E
Last Name:COLOM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 BRAMLEY LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0850
Mailing Address - Country:US
Mailing Address - Phone:407-782-5525
Mailing Address - Fax:386-943-9976
Practice Address - Street 1:452 OSCEOLA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7817
Practice Address - Country:US
Practice Address - Phone:407-782-5525
Practice Address - Fax:386-943-9976
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health