Provider Demographics
NPI:1912039785
Name:BOGAN, LINDSEY REBECCA (MS)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:REBECCA
Last Name:BOGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 OSWEGO ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4245
Mailing Address - Country:US
Mailing Address - Phone:661-549-8980
Mailing Address - Fax:
Practice Address - Street 1:210 S DE LACEY AVE STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2074
Practice Address - Country:US
Practice Address - Phone:626-831-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist