Provider Demographics
NPI:1518299866
Name:BOGUNOVICH, PAMELLA MAE (LCPC)
Entity Type:Individual
Prefix:
First Name:PAMELLA
Middle Name:MAE
Last Name:BOGUNOVICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-727-4315
Mailing Address - Fax:406-727-4318
Practice Address - Street 1:513 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/PACT
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3604
Practice Address - Country:US
Practice Address - Phone:406-727-4315
Practice Address - Fax:406-727-4318
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000745760OtherBLUE CROSS-SHIELD OF MONTANA