Healthcare Provider Details

I. General information

NPI: 1679822480
Provider Name (Legal Business Name): GENE L BOHLMANN ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 KATELLA AVE SUITE 207
LOS ALAMITOS CA
90720-3500
US

IV. Provider business mailing address

12501 SEAL BEACH BLVD STE 230
SEAL BEACH CA
90740-8815
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-9770
  • Fax: 714-226-9776
Mailing address:
  • Phone: 562-240-7780
  • Fax: 310-540-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27893
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: