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General NPI Number Information
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NPI Number | 1619966678
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Entity Type | Individual
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Provider Name | KATHERINE DIANE BOGUSHEFSKY MC, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 16515 S 40TH ST #139
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City | PHOENIX
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State | AZ
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Zip | 85048-0558
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Country | US
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Telephone | 480-205-4040
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Fax | 480-785-1647
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Provider Business Mailing Address
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Address Line | 16515 S 40TH ST STE 139
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City | PHOENIX
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State | AZ
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Zip | 85048-0560
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Country | US
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Telephone | 480-205-4040
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Fax | 480-785-1647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-10681
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License Number State | AZ
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