Healthcare Provider Details

I. General information

NPI: 1033718556
Provider Name (Legal Business Name): ANNETTE BOGARD, MS, LPC, NCC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 31ST ST
TULSA OK
74135
US

IV. Provider business mailing address

117 S SWEET GUM PLACE
BROKEN ARROW OK
74012-4568
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-1991
  • Fax:
Mailing address:
  • Phone: 316-680-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE BOGARD
Title or Position: THERAPIST
Credential: MS, LPC, NCC
Phone: 316-680-5760