Provider Demographics
NPI:1598444010
Name:BOGGS, MYLEY SUE
Entity type:Individual
Prefix:
First Name:MYLEY
Middle Name:SUE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24438 SANTA CLARA STREET
Mailing Address - Street 2:P.O. BOX 3702
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544
Mailing Address - Country:US
Mailing Address - Phone:510-519-1503
Mailing Address - Fax:
Practice Address - Street 1:45 BROOKSTONE WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2978
Practice Address - Country:US
Practice Address - Phone:510-951-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC18427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health