Basic Information
| Provider Information | |||||||||
| NPI: | 1205495447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGGS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ATCHESON ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432031353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142524941 | ||||||||
| FaxNumber: | 8559082509 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 ATCHESON ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432031353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142524941 | ||||||||
| FaxNumber: | 8559082509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C.1901957 | OH | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | LCDCIII.162196 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | E.2102554 | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.