Healthcare Provider Details

I. General information

NPI: 1982268553
Provider Name (Legal Business Name): BOHNENKAMP BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 POWERS AVE
LEWISTON ID
83501-6149
US

IV. Provider business mailing address

2020 POWERS AVE
LEWISTON ID
83501-6149
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-3776
  • Fax:
Mailing address:
  • Phone: 208-553-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA A BOHNENKAMP
Title or Position: OWNER/CLINICIAN
Credential: LCSW33391
Phone: 208-553-3776