| Doctor Name: | LAURIE BOHATY |
| NPI Number: | 1093177669 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | E10000330 |
| Business Practice Address: | 6140 S Broadway Lorain, OH - 440533821 |
| Business Phone Number: | 4402044228 |
| Business Fax Number: | 4402339070 |
| Mailing Address: | 6140 S Broadway, LORAIN |
| State: | OH |
| Postal Code: | 440533821 |
| Phone Number: | 4402044228 |
| Fax Number: | 4402339070 |
| NPI Enumeration Date: | 03/23/2016 |
| NPI Last Update Date: | 03/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | E10000330 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |