Provider Demographics
NPI:1154324473
Name:HOGG, JAMES ANDREW (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:HOGG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:408 N KENDRICK ST
Mailing Address - Street 2:STE 4
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1582
Mailing Address - Country:US
Mailing Address - Phone:928-774-6364
Mailing Address - Fax:928-556-0504
Practice Address - Street 1:408 N KENDRICK ST
Practice Address - Street 2:STE 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1582
Practice Address - Country:US
Practice Address - Phone:928-774-6364
Practice Address - Fax:928-556-0504
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1273103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0616270OtherBLUE CROSS BLUE SHIELD
AZ71358Medicare ID - Type UnspecifiedPSYCHOLOGIST
AZ147597OtherAHCCCS