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NPI Code Detail

MEDICARE: TERRENCE LEE BOGAN

MEDICARE: TERRENCE LEE BOGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1861287336
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRENCE LEE BOGAN
Provider Business Mailing Address
First Line : 3852 E 153RD ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-1112
Country : US
Telephone Number : 216-577-4921
Fax Number :
Provider Business Practice Location Address
First Line : 8411 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-3932
Country : US
Telephone Number : 216-441-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2025
Last Update Date : 04/14/2025

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Directions to “ TERRENCE LEE BOGAN ” Practice Location

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