Provider Demographics
NPI:1871038471
Name:BOGART, MISHA M (LPC)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:M
Last Name:BOGART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARLENE
Other - Last Name:BOGART-MONTEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4675 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4684
Mailing Address - Country:US
Mailing Address - Phone:720-326-2691
Mailing Address - Fax:
Practice Address - Street 1:4675 W HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4684
Practice Address - Country:US
Practice Address - Phone:720-295-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4976101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional