MEDICARE: MS. TARA LEA BOHLEY LMFT

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	106H00000X	Marriage & Family Therapist	936	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13325	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1326176637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA LEA BOHLEY LMFT

Provider Business Mailing Address
First Line	:	PO BOX 71533
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27722-1533
Country	:	US
Telephone Number	:	984-244-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 WRIGHT HILL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9093
Country	:	US
Telephone Number	:	984-244-0741
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	04/07/2022

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