Provider Demographics
NPI:1396379384
Name:BOGALE, ABEYOT NEGA
Entity Type:Individual
Prefix:
First Name:ABEYOT
Middle Name:NEGA
Last Name:BOGALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 4TH AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5907
Mailing Address - Country:US
Mailing Address - Phone:235-204-4683
Mailing Address - Fax:
Practice Address - Street 1:124 4TH AVE S STE 230
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5907
Practice Address - Country:US
Practice Address - Phone:235-204-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health