Provider Demographics
NPI:1487433025
Name:BOHNSACK, SEBRENA
Entity type:Individual
Prefix:
First Name:SEBRENA
Middle Name:
Last Name:BOHNSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3319
Mailing Address - Country:US
Mailing Address - Phone:817-480-6596
Mailing Address - Fax:
Practice Address - Street 1:2407 ACACIA ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3319
Practice Address - Country:US
Practice Address - Phone:817-480-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional