Active NPI
Leonard M Bohanon, PHD
- Clinical Psychologist
- Oak Ridge North, TX
National Provider Identifier
1124036702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2-2536
- Practice address
- 101 Pine Manor Dr
Oak Ridge North, TX 77385-9059 - Phone
- (832) 628-5253
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2-2536 | TX | Primary |
Addresses
Primary practice location
101 Pine Manor Dr
Oak Ridge North, TX 77385-9059
Mailing address
101 Pine Manor Dr
Oak Ridge North, TX 77385-9059
Phone (832) 628-5253
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 138628 | Other | VALUE OPTIONS | |
| 48145516 | Other | WAUSAU | |
| 030445301 | Medicaid | TX | |
| 225505 | Other | COMPSYCH | |
| 0015DL | Other | TX | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2-2536 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758240000000",
"number": "1124036702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 PINE MANOR DR",
"city": "OAK RIDGE NORTH",
"state": "TX",
"postal_code": "773859059",
"telephone_number": "832-628-5253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 PINE MANOR DR",
"city": "OAK RIDGE NORTH",
"state": "TX",
"postal_code": "773859059",
"telephone_number": "832-628-5253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHANON",
"first_name": "LEONARD",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2025-09-19",
"certification_date": "2025-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "2-2536",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "138628",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WAUSAU",
"identifier": "48145516",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "030445301",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPSYCH",
"identifier": "225505",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "0015DL",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Ridge North, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.