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General NPI Number Information
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NPI Number | 1699075838
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Entity Type | Organization
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Legal Business Name | MARIELLA L. HOGAN, PH.D., ATR-BC, PLLC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1010 W HAYS ST
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City | BOISE
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State | ID
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Zip | 83702-5435
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Country | US
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Telephone | 208-284-5273
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Fax | 208-344-1982
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Provider Business Mailing Address
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Address Line | 1010 W HAYS ST
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City | BOISE
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State | ID
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Zip | 83702-5435
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Country | US
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Telephone | 208-284-5273
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Fax | 208-344-1982
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST, OWNER, MGT
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Name | DR. MARIELLA L. HOGAN
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Credential | PH.D.
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Telephone | 208-284-5273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PSY-202270
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License Number State | ID
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