Provider Demographics
NPI:1699094656
Name:BOHLEY, MICHAEL FREDRICK (MS, THM, BCPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDRICK
Last Name:BOHLEY
Suffix:
Gender:M
Credentials:MS, THM, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12816-0215
Mailing Address - Country:US
Mailing Address - Phone:518-321-5250
Mailing Address - Fax:
Practice Address - Street 1:84 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1086
Practice Address - Country:US
Practice Address - Phone:518-321-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)