Healthcare Provider Details

I. General information

NPI: 1598291783
Provider Name (Legal Business Name): LINDA BOHNET LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date: 08/18/2018
Reactivation Date: 03/11/2020

III. Provider practice location address

4625 S LAKESHORE DR STE 411
TEMPE AZ
85282-7127
US

IV. Provider business mailing address

4625 S LAKESHORE DR STE 411
TEMPE AZ
85282-7127
US

V. Phone/Fax

Practice location:
  • Phone: 602-551-6747
  • Fax: 602-680-2541
Mailing address:
  • Phone: 602-551-6747
  • Fax: 602-680-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-16634
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16634
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: