Provider Demographics
NPI:1942935978
Name:BOHANEN, SIDNEY ROSS (MA LLPC)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:ROSS
Last Name:BOHANEN
Suffix:
Gender:M
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29600 PICKFORD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3464
Mailing Address - Country:US
Mailing Address - Phone:248-242-2055
Mailing Address - Fax:
Practice Address - Street 1:29600 PICKFORD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3464
Practice Address - Country:US
Practice Address - Phone:248-242-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health