Healthcare Provider Details

I. General information

NPI: 1265893226
Provider Name (Legal Business Name): TARYN BOGONOVICH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E CAMPBELL AVE STE 122
CAMPBELL CA
95008-2046
US

IV. Provider business mailing address

155 E CAMPBELL AVE STE 122
CAMPBELL CA
95008-2046
US

V. Phone/Fax

Practice location:
  • Phone: 408-508-4445
  • Fax:
Mailing address:
  • Phone: 408-508-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC89882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: