Provider Demographics
NPI:1932836780
Name:BOGART, JOSHUA D
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:BOGART
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 1:727 N DEERLANE LOOP
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368-9677
Mailing Address - Country:US
Mailing Address - Phone:928-848-6430
Mailing Address - Fax:503-925-6322
Practice Address - Street 1:727 N DEERLANE LOOP
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9677
Practice Address - Country:US
Practice Address - Phone:928-848-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty