Provider Demographics
NPI:1083336341
Name:BOGUTZ, MEGHAN (LCSWA, LCASA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:BOGUTZ
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CAROLINA PINES CT
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-6425
Mailing Address - Country:US
Mailing Address - Phone:614-607-1626
Mailing Address - Fax:
Practice Address - Street 1:13 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-1007
Practice Address - Country:US
Practice Address - Phone:828-649-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health