Provider Demographics
NPI:1265934335
Name:BOEHLER, DONN (CDCA)
Entity type:Individual
Prefix:
First Name:DONN
Middle Name:
Last Name:BOEHLER
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1903
Mailing Address - Country:US
Mailing Address - Phone:412-715-8646
Mailing Address - Fax:
Practice Address - Street 1:11155 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-1903
Practice Address - Country:US
Practice Address - Phone:412-715-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165283101YA0400X
OH168687101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)