Provider Demographics
NPI:1073831905
Name:BOGDANOS, STAMATIS TAKIS (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:STAMATIS TAKIS
Middle Name:
Last Name:BOGDANOS
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:MR
Other - First Name:TAKIS
Other - Middle Name:
Other - Last Name:BOGDANOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S
Mailing Address - Street 1:1322 SPACE PARK DR STE C105A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3582
Mailing Address - Country:US
Mailing Address - Phone:281-317-0215
Mailing Address - Fax:
Practice Address - Street 1:1322 SPACE PARK DR STE C105A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3582
Practice Address - Country:US
Practice Address - Phone:281-317-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional