Provider Demographics
NPI:1447918503
Name:BOHON, RANDY
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:BOHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33571-5571
Mailing Address - Country:US
Mailing Address - Phone:813-906-9552
Mailing Address - Fax:
Practice Address - Street 1:11423 SUNBURST MARBLE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2106
Practice Address - Country:US
Practice Address - Phone:813-906-9552
Practice Address - Fax:843-808-2254
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21904101YM0800X
FLMH23444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health