Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | E 0000088 | OH |
NPI | 1003235565 |
---|---|
Provider Name | Carl Bogenschutz |
First Address | Columbus, OH 43201-2460 |
Second Address | Columbus, OH 43201-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 14/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0274411 | (05) | OH |