MEDICARE: DR. GREG T BOHALL PSY.D.

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	103TC0700X	Clinical Psychologist	35655	CA

General Provider Information

NPI Number	:	1154273605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREG T BOHALL PSY.D.

Provider Business Mailing Address
First Line	:	10661 CHESTNUT ST
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2143
Country	:	US
Telephone Number	:	213-219-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	10661 CHESTNUT ST
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2143
Country	:	US
Telephone Number	:	213-219-7233
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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