Provider Demographics
NPI:1477632883
Name:BOHNERT, LORI BETH (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:BOHNERT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 W SR 434 STE 400
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4455
Mailing Address - Country:US
Mailing Address - Phone:407-449-0751
Mailing Address - Fax:
Practice Address - Street 1:2973 W SR 434 STE 400
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4455
Practice Address - Country:US
Practice Address - Phone:407-449-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health