Provider Demographics
NPI:1093137747
Name:BOHLMANN, STACEY DAWN (LPC-MH, LAC, QMHP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DAWN
Last Name:BOHLMANN
Suffix:
Gender:F
Credentials:LPC-MH, LAC, QMHP
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 294
Mailing Address - Street 2:
Mailing Address - City:OGLALA
Mailing Address - State:SD
Mailing Address - Zip Code:57764-0284
Mailing Address - Country:US
Mailing Address - Phone:605-899-0027
Mailing Address - Fax:
Practice Address - Street 1:2337 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7081
Practice Address - Country:US
Practice Address - Phone:605-237-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2252101Y00000X
SDLPC-MH2252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor