Provider Demographics
NPI:1972232270
Name:BOHART, JAYNEE (PMHL)
Entity Type:Individual
Prefix:
First Name:JAYNEE
Middle Name:
Last Name:BOHART
Suffix:
Gender:F
Credentials:PMHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ATOKAD DR TRLR 261
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-5439
Mailing Address - Country:US
Mailing Address - Phone:253-259-0866
Mailing Address - Fax:
Practice Address - Street 1:104 S COSTELLO ST
Practice Address - Street 2:
Practice Address - City:WALTHILL
Practice Address - State:NE
Practice Address - Zip Code:68067
Practice Address - Country:US
Practice Address - Phone:402-475-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health