Provider Demographics
NPI:1053630442
Name:BOGAN, STEPHEN PETER (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PETER
Last Name:BOGAN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930-S.W. POHL ROAD
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-8712
Mailing Address - Country:US
Mailing Address - Phone:206-463-3050
Mailing Address - Fax:206-463-6137
Practice Address - Street 1:6407 FAUNTLEROY S.W.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1820
Practice Address - Country:US
Practice Address - Phone:206-463-3050
Practice Address - Fax:206-463-6137
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor