=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811871296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZANDA JONNEATHA BOGGS LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 08/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1612 HIGHWAY 44 E
-----------------------------------------------------
City | SHEPHERDSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40165-6129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-270-1515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 BIRDIE AVE
-----------------------------------------------------
City | CAMPBELLSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42718-9476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-283-7031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 301046
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------