Provider Demographics
NPI:1376024307
Name:BARTHOLOMAY, JASON (MA, LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BARTHOLOMAY
Suffix:
Gender:M
Credentials:MA, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVENUE
Mailing Address - Street 2:WEST BLDG F-140
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1400
Mailing Address - Country:US
Mailing Address - Phone:612-273-4466
Mailing Address - Fax:612-273-4444
Practice Address - Street 1:2450 RIVERSIDE AVENUE
Practice Address - Street 2:WEST BLDG F-140
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1400
Practice Address - Country:US
Practice Address - Phone:612-273-4466
Practice Address - Fax:612-273-4444
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303671101YA0400X
MN3491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)