Provider Demographics
NPI:1679822217
Name:BOGGS, LEANNE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:MS, LPC
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 224
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-0224
Mailing Address - Country:US
Mailing Address - Phone:417-345-0609
Mailing Address - Fax:417-345-1121
Practice Address - Street 1:1336 S ASH ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622
Practice Address - Country:US
Practice Address - Phone:417-345-0609
Practice Address - Fax:417-345-1121
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional