Provider Demographics
NPI:1699075838
Name:MARIELLA L. HOGAN, PH.D., ATR-BC, PLLC
Entity type:Organization
Organization Name:MARIELLA L. HOGAN, PH.D., ATR-BC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER, MGT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-284-5273
Mailing Address - Street 1:1010 W HAYS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5435
Mailing Address - Country:US
Mailing Address - Phone:208-284-5273
Mailing Address - Fax:208-344-1982
Practice Address - Street 1:1010 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5435
Practice Address - Country:US
Practice Address - Phone:208-284-5273
Practice Address - Fax:208-344-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202270261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)