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General NPI Number Information
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NPI Number | 1982268553
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Entity Type | Organization
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Legal Business Name | BOHNENKAMP BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 609 BRYDEN AVE STE B
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City | LEWISTON
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State | ID
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Zip | 83501-5193
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Country | US
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Telephone | 208-553-3776
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Fax | 208-413-9976
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Provider Business Mailing Address
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Address Line | 609 BRYDEN AVE STE B
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City | LEWISTON
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State | ID
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Zip | 83501-5193
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Country | US
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Telephone | 208-553-3776
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | REBECCA ANN BOHNENKAMP
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Credential | LCSW
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Telephone | 208-553-3776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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