Individual
AMY L BOHANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA,LBA, LPC-MHSP
Contact information
Practice address
1910 MALABAR DR, GERMANTOWN, TN 38138-3025
(651) 341-1858
Mailing address
1910 MALABAR DR, GERMANTOWN, TN 38138-3025
(651) 341-1858
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6896
TN
103K00000X
Behavior Analyst
051
TN
103K00000X
Behavior Analyst
1-08-4872
MN
Other
Enumeration date
09/28/2010
Last updated
07/10/2025
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