Provider Demographics
NPI:1891138814
Name:BOHALL, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BOHALL
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 1:899 VALLEJO TER
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2451
Mailing Address - Country:US
Mailing Address - Phone:805-550-3223
Mailing Address - Fax:
Practice Address - Street 1:899 VALLEJO TER
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2451
Practice Address - Country:US
Practice Address - Phone:805-550-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 75172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist