Provider Demographics
NPI:1457806929
Name:BOHNEN, WILLIAM J (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BOHNEN
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 FREMONT AVE N
Mailing Address - Street 2:#121
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2462
Mailing Address - Country:US
Mailing Address - Phone:612-236-6393
Mailing Address - Fax:
Practice Address - Street 1:3232 FREMONT AVE N
Practice Address - Street 2:#121
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2462
Practice Address - Country:US
Practice Address - Phone:612-236-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303377101YA0400X
MNCC00854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)