Provider Demographics
NPI:1619145000
Name:HOGUE, THAKENA DERIESS (MA, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:THAKENA
Middle Name:DERIESS
Last Name:HOGUE
Suffix:
Gender:F
Credentials:MA, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N CAPITOL AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1218
Mailing Address - Country:US
Mailing Address - Phone:317-962-2486
Mailing Address - Fax:
Practice Address - Street 1:1812 N CAPITOL AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1218
Practice Address - Country:US
Practice Address - Phone:317-962-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001904A101YM0800X
IN35001646A106H00000X
IN87000284A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000538795OtherANTHEM