Provider Demographics
NPI:1144755687
Name:BOGNER, WILLIAM (MFTI 97374)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOGNER
Suffix:
Gender:M
Credentials:MFTI 97374
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 OCEANO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-2221
Mailing Address - Country:US
Mailing Address - Phone:805-450-3266
Mailing Address - Fax:
Practice Address - Street 1:310 OCEANO AVE APT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-2221
Practice Address - Country:US
Practice Address - Phone:805-450-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health