Provider Demographics
NPI:1265062020
Name:CHRISTIAN BOGH PROFESSIONAL CLINICAL COUNSELOR INC.
Entity type:Organization
Organization Name:CHRISTIAN BOGH PROFESSIONAL CLINICAL COUNSELOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:GARTH
Authorized Official - Last Name:BOGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-709-2071
Mailing Address - Street 1:5790 MAGNOLIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1874
Mailing Address - Country:US
Mailing Address - Phone:909-709-2071
Mailing Address - Fax:951-346-3333
Practice Address - Street 1:5790 MAGNOLIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1874
Practice Address - Country:US
Practice Address - Phone:909-709-2071
Practice Address - Fax:951-346-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA116200OtherCA STATE LMFT LICENSE NUMBER