Provider Demographics
NPI:1730658899
Name:BOHM-HARRINGTON, CHRISTINA ANN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:BOHM-HARRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:BOHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 BETHANY DR STE C
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2803
Mailing Address - Country:US
Mailing Address - Phone:844-322-7483
Mailing Address - Fax:888-334-7021
Practice Address - Street 1:125 BETHANY DR STE C
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-2803
Practice Address - Country:US
Practice Address - Phone:844-322-7483
Practice Address - Fax:888-334-7021
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-59321103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician