Provider Demographics
NPI:1821774753
Name:BOHANON, ASHLEE
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:BOHANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 HALLE TRACE LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047
Mailing Address - Country:US
Mailing Address - Phone:707-398-5103
Mailing Address - Fax:
Practice Address - Street 1:3310 HALLE TRACE LANE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047
Practice Address - Country:US
Practice Address - Phone:707-398-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical