Provider Demographics
NPI:1295441483
Name:BOHRER, JEREMY NORMAN (AMFT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:NORMAN
Last Name:BOHRER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W SOLA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3039
Mailing Address - Country:US
Mailing Address - Phone:707-364-4238
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93111-2066
Practice Address - Country:US
Practice Address - Phone:805-232-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT137143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health