1619966678 NPI number — MRS. KATHERINE DIANE BOGUSHEFSKY MC, LPC

Table of content: MRS. KATHERINE DIANE BOGUSHEFSKY MC, LPC (NPI 1619966678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619966678 NPI number — MRS. KATHERINE DIANE BOGUSHEFSKY MC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGUSHEFSKY
Provider First Name:
KATHERINE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUHN
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619966678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16515 S 40TH ST STE 139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85048-0560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-205-4040
Provider Business Mailing Address Fax Number:
480-785-1647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16515 S 40TH ST
Provider Second Line Business Practice Location Address:
#139
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85048-0558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-205-4040
Provider Business Practice Location Address Fax Number:
480-785-1647
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-10681 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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