Provider Demographics
NPI:1750600920
Name:BOGGS, RICHARD EMMETT (LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EMMETT
Last Name:BOGGS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40400 ANN ARBOR RD E
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6615
Mailing Address - Country:US
Mailing Address - Phone:734-276-3952
Mailing Address - Fax:734-416-5990
Practice Address - Street 1:40400 ANN ARBOR RD E
Practice Address - Street 2:SUITE 104A
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6615
Practice Address - Country:US
Practice Address - Phone:734-276-3952
Practice Address - Fax:734-416-5990
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional