Provider Demographics
NPI:1023778586
Name:BOGGS, TERISE ROBIN (LPC)
Entity type:Individual
Prefix:
First Name:TERISE
Middle Name:ROBIN
Last Name:BOGGS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 WILLIAMS DR STE 302
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1369
Mailing Address - Country:US
Mailing Address - Phone:512-942-7997
Mailing Address - Fax:
Practice Address - Street 1:3613 WILLIAMS DR STE 302
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1369
Practice Address - Country:US
Practice Address - Phone:512-317-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional