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NPI Code Detail

MEDICARE: JENE DENISE BUGENHAGEN LPC, NCC

MEDICARE: JENE DENISE BUGENHAGEN LPC, NCC
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
1101YM0800XMental Health CounselorAPC009841GA

General Provider Information

NPI Number : 1912763673
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENE DENISE BUGENHAGEN LPC, NCC
Provider Business Mailing Address
First Line : 2643 MADISON MAE LN
Second Line :
City : GRAYSON
State : GA
Zip : 30017-7822
Country : US
Telephone Number : 770-354-7073
Fax Number :
Provider Business Practice Location Address
First Line : 678 TOM BREWER RD
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-4005
Country : US
Telephone Number : 770-354-7073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2024
Last Update Date : 05/09/2026

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