Jack Roy Bohanon, MFT Valid NPI

Individual provider · Mental Health Counselor · Palo Alto, CA

NPI

1508947706

Type

Individual (Type 1)

Primary specialty

Mental Health Counselor (Counselor)

Specialty group

Behavioral Health & Social Service Providers

Taxonomy code

101YM0800X

License number

MFC29822 (CA)

Sex

Male

Sole proprietor

Yes

Enumerated

2006-10-17

Last updated

2025-09-11