Healthcare Provider Details

I. General information

NPI: 1144755687
Provider Name (Legal Business Name): WILLIAM BOGNER III LMFT 13798387-3902
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E WHITE ST
SARATOGA SPRINGS UT
84045-6570
US

IV. Provider business mailing address

1329 E WHITE ST
SARATOGA SPRINGS UT
84045-6570
US

V. Phone/Fax

Practice location:
  • Phone: 805-450-3266
  • Fax:
Mailing address:
  • Phone: 805-450-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13798387-3902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: