Provider Demographics
NPI:1396040556
Name:BOGU, BRANDY (P-960)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BOGU
Suffix:
Gender:F
Credentials:P-960
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3764
Mailing Address - Country:US
Mailing Address - Phone:308-532-8300
Mailing Address - Fax:
Practice Address - Street 1:425 N OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3764
Practice Address - Country:US
Practice Address - Phone:308-532-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)