Provider Demographics
NPI:1730572439
Name:HOGAN, ANNETTA (MS)
Entity type:Individual
Prefix:MRS
First Name:ANNETTA
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 BEAR MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1850
Mailing Address - Country:US
Mailing Address - Phone:702-501-6076
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3195
Practice Address - Country:US
Practice Address - Phone:702-778-5300
Practice Address - Fax:702-778-5301
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist