Provider Demographics
NPI:1598196123
Name:BOHANON, KRISTI ROBIN (LPCC-S, NBCC, QMPH)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:ROBIN
Last Name:BOHANON
Suffix:
Gender:F
Credentials:LPCC-S, NBCC, QMPH
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ROBIN
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, NCC, QMHP
Mailing Address - Street 1:615 ELSINORE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1457
Mailing Address - Country:US
Mailing Address - Phone:833-510-4357
Mailing Address - Fax:866-460-2997
Practice Address - Street 1:4135 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018-1815
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:866-460-2997
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0383101YP2500X
KY308609101YP2500X
KY103411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100393920Medicaid