Healthcare Provider Details

I. General information

NPI: 1295541118
Provider Name (Legal Business Name): CHRISTIAN BOGGS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LEESTOWN RD STE 232
LEXINGTON KY
40511-9266
US

IV. Provider business mailing address

1500 LEESTOWN RD STE 232
LEXINGTON KY
40511-9266
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number294394
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: