Provider Demographics
NPI:1033468822
Name:BOHANNON-OXFORD, RENE KERRY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:RENE
Middle Name:KERRY
Last Name:BOHANNON-OXFORD
Suffix:
Gender:F
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:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626
Mailing Address - Country:US
Mailing Address - Phone:360-261-8467
Mailing Address - Fax:360-414-8906
Practice Address - Street 1:2707 PACIFIC AVE NORTH
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626
Practice Address - Country:US
Practice Address - Phone:360-261-8467
Practice Address - Fax:360-414-8906
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMHC#60085935101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor