Female

Mrs. Tracy A. Bohannon M.E.D

Mental Health Counselor in Jacksonville, FL(View on Map)

Full Name

Mrs. Tracy Aidan Bohannon M.E.D

NPI Number

1023207453

NPI Type

Individual Provider

Gender

Female

Enumeration Date

10/22/2007

Specialties

(Taxonomies)

Code

101YM0800X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

MH23300

Contact
Information

Purpose

Mailing
Location

Address

11461 CONN RD
4720 SALISBURY RD

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32218-2167
32256-6101

Country

US
US

Telephone Number

(904) 858-1963
(904) 206-8405

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/14/2024

Provider Address

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