Provider Demographics
NPI:1871049304
Name:BOMAN, JAIMEE LEANNE (LMFT 127340)
Entity type:Individual
Prefix:
First Name:JAIMEE
Middle Name:LEANNE
Last Name:BOMAN
Suffix:
Gender:F
Credentials:LMFT 127340
Other - Prefix:
Other - First Name:JAIMEE
Other - Middle Name:LEANNE
Other - Last Name:OHLANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3725 TAYLOR RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9283
Mailing Address - Country:US
Mailing Address - Phone:916-652-5814
Mailing Address - Fax:
Practice Address - Street 1:3725 TAYLOR RD STE 1
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-9283
Practice Address - Country:US
Practice Address - Phone:916-652-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 390200000X
CA127340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program