Provider Demographics
NPI:1174897748
Name:BOHN, RALPH TERRY JR (REGISTERED THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:TERRY
Last Name:BOHN
Suffix:JR
Gender:M
Credentials:REGISTERED THERAPIST
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:BOHN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:155 W HARVARD ST
Mailing Address - Street 2:#401 - RESTORATION COUNSELING
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5200
Mailing Address - Country:US
Mailing Address - Phone:720-608-9778
Mailing Address - Fax:
Practice Address - Street 1:155 W HARVARD ST
Practice Address - Street 2:#401 - RESTORATION COUNSELING
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5200
Practice Address - Country:US
Practice Address - Phone:720-608-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0105141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONLC.0105141OtherDIVISION OF PROFESSIONS AND OCCUPATIONS
WAMC 60371723OtherWASHINGTON DEPARTMENT OF HEALTH