Basic Information
| Provider Information | |||||||||
| NPI: | 1407173156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOGGS | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 AMHURST CIR | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460629009 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6640 INTECH BLVD | ||||||||
| Address2: | STE 195 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462782011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172950608 | ||||||||
| FaxNumber: | 3172950622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 20042620A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 101YM0800X | 39001985A | IN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.