Provider Demographics
NPI:1851504740
Name:MOHAN, BONITA R (MSW, BHP)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:R
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MSW, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL STAFF DEPARTMENT
Mailing Address - Street 2:P.O. BOX 130
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-9218
Mailing Address - Fax:907-842-9250
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-842-9218
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10-019-BHP101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor