Provider Demographics
NPI:1205495447
Name:BOGGS, THOMAS EVAN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EVAN
Last Name:BOGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ATCHESON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1353
Mailing Address - Country:US
Mailing Address - Phone:614-252-4941
Mailing Address - Fax:855-908-2509
Practice Address - Street 1:1000 ATCHESON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1353
Practice Address - Country:US
Practice Address - Phone:614-252-4941
Practice Address - Fax:855-908-2509
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901957101Y00000X
OHLCDCIII.162196101YA0400X
OHE.2102554101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)