Healthcare Provider Details

I. General information

NPI: 1669977864
Provider Name (Legal Business Name): RICHARD DAVID BOHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W COLUMBUS ST
BAKERSFIELD CA
93301-1263
US

IV. Provider business mailing address

6700 KLAMATH WAY APT A
BAKERSFIELD CA
93309-7886
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-0245
  • Fax:
Mailing address:
  • Phone: 661-932-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1669977864
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1296270318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: