Provider Demographics
NPI:1083071203
Name:BOGGAN, LAURA F (MS NCP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:F
Last Name:BOGGAN
Suffix:
Gender:F
Credentials:MS NCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 W MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1323
Mailing Address - Country:US
Mailing Address - Phone:615-444-1880
Mailing Address - Fax:615-444-7411
Practice Address - Street 1:1432 W MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1323
Practice Address - Country:US
Practice Address - Phone:615-444-1880
Practice Address - Fax:615-444-7411
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health