=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477555480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIK BOHLIN M.A., LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2005
-----------------------------------------------------
Last Update Date | 06/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9623 32ND ST SE STE 110
-----------------------------------------------------
City | LAKE STEVENS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98258-5779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-334-8916
-----------------------------------------------------
Fax | 425-368-3738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9623 32ND ST SE STE A110
-----------------------------------------------------
City | LAKE STEVENS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98258-5797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-334-8916
-----------------------------------------------------
Fax | 425-368-3738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LH00004543
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------