MEDICARE: MRS. MICHELLE MILLER BOHLS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	201086	TX

General Provider Information

NPI Number	:	1184953531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MILLER BOHLS LMFT

Provider Business Mailing Address
First Line	:	8500 SHOAL CREEK BLVD BLDG IV
Second Line	:	SUITE 170
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-577-3371
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 SHOAL CREEK BLVD BLDG IV
Second Line	:	SUITE 170
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-577-3371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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