MEDICARE: RACHAEL BOHLING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8631957-3902	UT

General Provider Information

NPI Number	:	1053820167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL BOHLING

Provider Business Mailing Address
First Line	:	439 E 900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4303
Country	:	US
Telephone Number	:	801-203-0558
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 E 900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	CA
Zip	:	84109-8410
Country	:	US
Telephone Number	:	801-203-0558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	09/21/2017

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