Healthcare Provider Details

I. General information

NPI: 1982161949
Provider Name (Legal Business Name): DANIELLE NICHOLE BOGAN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 GARFIELD AVE
SACRAMENTO CA
95841-2009
US

IV. Provider business mailing address

180 PROMENADE CIR
SACRAMENTO CA
95834-2939
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone: 916-642-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: