Provider Demographics
NPI:1225203409
Name:BOHLEN, STEPHEN LEO (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEO
Last Name:BOHLEN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-9124
Mailing Address - Country:US
Mailing Address - Phone:515-520-2074
Mailing Address - Fax:
Practice Address - Street 1:2507 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-9124
Practice Address - Country:US
Practice Address - Phone:515-520-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health