Provider Demographics
NPI:1174833230
Name:BUGONI, MEGAN ANISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ANISA
Last Name:BUGONI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ANISA
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2009 S 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3426
Mailing Address - Country:US
Mailing Address - Phone:406-829-5421
Mailing Address - Fax:406-829-5430
Practice Address - Street 1:2687 PALMER ST STE C-2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1710
Practice Address - Country:US
Practice Address - Phone:406-829-5421
Practice Address - Fax:406-829-5430
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health