Provider Demographics
NPI:1225321334
Name:BOGART, TOM (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:BOGART
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 COACHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7318
Mailing Address - Country:US
Mailing Address - Phone:832-489-6225
Mailing Address - Fax:
Practice Address - Street 1:6422 COACHGATE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7318
Practice Address - Country:US
Practice Address - Phone:832-489-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65389101YP2500X
TX201530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional