Provider Demographics
NPI:1770730293
Name:BOEHM, WILLIAM PAUL (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:BOEHM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 MOTOR AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034
Mailing Address - Country:US
Mailing Address - Phone:310-837-2444
Mailing Address - Fax:310-837-5332
Practice Address - Street 1:4199 CAMPUS DRIVE
Practice Address - Street 2:SUITE 550
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612
Practice Address - Country:US
Practice Address - Phone:949-509-6554
Practice Address - Fax:949-509-6599
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist