MEDICARE: ALICIA BOGGESS MFT-I

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
1	106H00000X	Marriage & Family Therapist	2305	TN

General Provider Information

NPI Number	:	1992487037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BOGGESS MFT-I

Provider Business Mailing Address
First Line	:	2500 EXECUTIVE PARK NW STE 5C
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 EXECUTIVE PARK NW STE 5C
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2751
Country	:	US
Telephone Number	:	423-414-4307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “ ALICIA BOGGESS MFT-I” Practice Location

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