Provider Demographics
NPI:1760132328
Name:BOGUNA FALCO, CRISTINA (QMHP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:BOGUNA FALCO
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGH ST SE
Mailing Address - Street 2:STE 232
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:541-757-8068
Mailing Address - Fax:541-758-1030
Practice Address - Street 1:161 HIGH ST SE
Practice Address - Street 2:STE 232
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:541-818-0009
Practice Address - Fax:541-758-1030
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORR8399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128715Medicaid