Provider Demographics
NPI:1801309364
Name:BOGDANOVIC, MOLLY (LPC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BOGDANOVIC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 SW MADISON AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4924
Mailing Address - Country:US
Mailing Address - Phone:503-409-1749
Mailing Address - Fax:541-766-6186
Practice Address - Street 1:257 SW MADISON AVE STE 226
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4924
Practice Address - Country:US
Practice Address - Phone:503-409-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional