Provider Demographics
NPI:1245421395
Name:BOGGS, SHAWN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:BOGGS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 KINWEST PKWY
Mailing Address - Street 2:107
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3407
Mailing Address - Country:US
Mailing Address - Phone:972-910-8388
Mailing Address - Fax:972-910-8366
Practice Address - Street 1:1075 KINWEST PKWY
Practice Address - Street 2:107
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3407
Practice Address - Country:US
Practice Address - Phone:972-910-8388
Practice Address - Fax:972-910-8366
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist