Individual ProviderEdna Jeannene BohannonMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5299 - College Ave., Suite 6, Oakland, CA 94618(510) 351-5271PECOS EnrollmentBased on the most recent information from CMS, provider Edna Jeannene Bohannon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1811127749Provider TypeIndividualFull NameBohannon, Edna JeanneneCredentialPH.D., MFTGenderFemaleSole ProprietorYesEnumeration Date7/27/2009Last Updated7/27/2009Contact InformationPractice LocationPractice Address5299 - College Ave., Suite 6, Oakland, CA 94618Phone(510) 351-5271Fax(510) 351-4378Mailing LocationMailing Address939 - Collier Drive, San Leandro, CA 94577Phone(510) 351-5271Fax(510) 351-4378Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC.21208California