Healthcare Provider Details

I. General information

NPI: 1376170720
Provider Name (Legal Business Name): LISA BOHACEK HURT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 STEPHEN RD
BURBANK CA
91504-1945
US

IV. Provider business mailing address

818 STEPHEN RD
BURBANK CA
91504-1945
US

V. Phone/Fax

Practice location:
  • Phone: 818-324-0186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT124029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: