Provider Demographics
NPI:1104007269
Name:BOEHM, RICK D (LMHC, MAC, MS)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:D
Last Name:BOEHM
Suffix:
Gender:M
Credentials:LMHC, MAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3331
Mailing Address - Country:US
Mailing Address - Phone:360-906-8160
Mailing Address - Fax:360-906-8194
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3331
Practice Address - Country:US
Practice Address - Phone:360-906-8160
Practice Address - Fax:360-906-8194
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002340101YA0400X
WAMAC501835101YA0400X
WALH00005696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)