Provider Demographics
NPI:1710184676
Name:BOHANNAN, BREANA J (MHR)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:J
Last Name:BOHANNAN
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 S SHERIDAN RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5751
Mailing Address - Country:US
Mailing Address - Phone:918-384-0002
Mailing Address - Fax:918-384-0004
Practice Address - Street 1:560 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:469-470-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health