Provider Demographics
NPI:1346404324
Name:BOHLEY, JONATHAN PAUL (MA, PC, LCDC III)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAUL
Last Name:BOHLEY
Suffix:
Gender:M
Credentials:MA, PC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-723-9600
Mailing Address - Fax:330-722-1446
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-723-9600
Practice Address - Fax:330-722-1446
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0501075-CR101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health