Provider Demographics
NPI:1952931362
Name:BOGH, CHRISTIAN GARTH
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:GARTH
Last Name:BOGH
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 1:5790 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
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional