MEDICARE: TARA BOHLEY LMFT PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1275286825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA BOHLEY LMFT PLLC

Provider Business Mailing Address
First Line	:	PO BOX 71533
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27722-1533
Country	:	US
Telephone Number	:	984-244-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 WRIGHT HILL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9093
Country	:	US
Telephone Number	:	336-971-7362
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	TARA BOHLEY
Credential	:	LMFT
Telephone Number	:	984-244-0741

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	04/07/2022

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