Provider Demographics
NPI:1417079633
Name:HENSON BOHLEN, MARK DONALD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DONALD
Last Name:HENSON BOHLEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091
Mailing Address - Country:US
Mailing Address - Phone:269-503-0336
Mailing Address - Fax:
Practice Address - Street 1:401 S FOURTH STREET
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091
Practice Address - Country:US
Practice Address - Phone:269-659-4530
Practice Address - Fax:269-659-7678
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010871321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical