Provider Demographics
NPI:1871857342
Name:BOGGS, KRISTIE MICHELLE (NCC, CI)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MICHELLE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:NCC, CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 BLUEBONNET BLVD
Mailing Address - Street 2:APT. 1-2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7800
Mailing Address - Country:US
Mailing Address - Phone:713-530-1850
Mailing Address - Fax:
Practice Address - Street 1:1112 E ASCENSION COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4265
Practice Address - Country:US
Practice Address - Phone:225-450-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor