Provider Demographics
NPI:1790890374
Name:BARTHOLOME, LOUIS STEPHEN (MA, LP)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:STEPHEN
Last Name:BARTHOLOME
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 PRAIRIE LAKES DR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3885
Mailing Address - Country:US
Mailing Address - Phone:952-746-6164
Mailing Address - Fax:952-942-5141
Practice Address - Street 1:11000 PRAIRIE LAKES DR
Practice Address - Street 2:SUITE 610
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3885
Practice Address - Country:US
Practice Address - Phone:952-746-6164
Practice Address - Fax:952-942-5141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1392103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist