Provider Demographics
NPI:1255656617
Name:BOHY, NATHAN (PSYD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BOHY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE STE A208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2967
Mailing Address - Country:US
Mailing Address - Phone:619-630-7208
Mailing Address - Fax:619-924-8122
Practice Address - Street 1:3990 OLD TOWN AVE STE A208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2967
Practice Address - Country:US
Practice Address - Phone:619-630-7208
Practice Address - Fax:619-924-8122
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27810103TC0700X
CALICENCE WAIVERED103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical