Individual
BETHANY BOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3003 4TH AVE, SAN DIEGO, CA 92103-5801
(888) 428-3223
(323) 866-1881
Mailing address
4221 WILSHIRE BLVD STE 300A, LOS ANGELES, CA 90010-3537
(888) 428-3223
(323) 866-1881
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-47819
CA
106S00000X
Behavior Technician
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-21-47819
BACB
CA
Enumeration date
07/15/2019
Last updated
10/13/2025
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