Provider Demographics
NPI:1114276102
Name:JOLMAN, SAMUEL J (LPC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:JOLMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:JOLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPC
Mailing Address - Street 1:614 N NEVADA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-5021
Mailing Address - Country:US
Mailing Address - Phone:719-447-7446
Mailing Address - Fax:888-447-9272
Practice Address - Street 1:614 N NEVADA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5021
Practice Address - Country:US
Practice Address - Phone:719-447-7446
Practice Address - Fax:888-447-9272
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
271771060OtherEIN