Provider Demographics
NPI:1629118765
Name:BOGUE-GILMORE, ANGELA M (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:BOGUE-GILMORE
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 N LOCH LOMOND CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67228
Mailing Address - Country:US
Mailing Address - Phone:316-631-1280
Mailing Address - Fax:316-631-1422
Practice Address - Street 1:2509 N LOCH LOMOND COURT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67228
Practice Address - Country:US
Practice Address - Phone:316-631-1280
Practice Address - Fax:316-631-1422
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS393645OtherBLUE CROSS BLUE SHIELD ID