Provider Demographics
NPI:1932670429
Name:BOHANNON PROFESSIONAL COUNSELING, PLLC
Entity Type:Organization
Organization Name:BOHANNON PROFESSIONAL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:701-240-4390
Mailing Address - Street 1:24 MAIN ST N STE E
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3104
Mailing Address - Country:US
Mailing Address - Phone:701-240-4390
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST N STE E
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-3104
Practice Address - Country:US
Practice Address - Phone:701-240-4390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty