Provider Demographics
NPI:1033885702
Name:BOHN, LESLIE (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BOHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SPRING ST APT U4
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4507
Mailing Address - Country:US
Mailing Address - Phone:605-670-7463
Mailing Address - Fax:
Practice Address - Street 1:606 E SPRING ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5066
Practice Address - Country:US
Practice Address - Phone:931-303-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health