Provider Demographics
NPI:1912763673
Name:BUGENHAGEN, JENE DENISE
Entity Type:Individual
Prefix:
First Name:JENE
Middle Name:DENISE
Last Name:BUGENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 MADISON MAE LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7822
Mailing Address - Country:US
Mailing Address - Phone:770-354-7073
Mailing Address - Fax:
Practice Address - Street 1:678 TOM BREWER RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4005
Practice Address - Country:US
Practice Address - Phone:770-354-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health