Healthcare Provider Details

I. General information

NPI: 1942011085
Provider Name (Legal Business Name): MELANIE BOGUS MA, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 DOUGLAS AVE STE 2040
ALTAMONTE SPRINGS FL
32714-2004
US

IV. Provider business mailing address

1110 DOUGLAS AVE STE 2040
ALTAMONTE SPRINGS FL
32714-2004
US

V. Phone/Fax

Practice location:
  • Phone: 407-565-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27144
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: