Provider Demographics
NPI:1154673382
Name:BOHANNON, LYNDSAY (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:LYNDSAY
Middle Name:
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N LAPEER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3159
Mailing Address - Country:US
Mailing Address - Phone:248-693-9614
Mailing Address - Fax:
Practice Address - Street 1:45 N LAPEER ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3159
Practice Address - Country:US
Practice Address - Phone:248-693-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014735103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling