Lindsay Bogan

Key facts

NPI

1043064017

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

8668 (SC)

Practice address

134 Oakland Ave
Spartanburg, SC 29302-1617

Phone

(864) 921-4560

NPI assigned

Apr 15, 2024

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 15, 2024.

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1043064017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 BROOMAGE CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296808046",
            "telephone_number": "864-921-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 OAKLAND AVE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021617",
            "telephone_number": "864-921-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGAN",
        "first_name": "LINDSAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "SC",
            "license": "8668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Spartanburg, SC · Marriage & Family Therapist in South Carolina