Provider Demographics
NPI:1043749427
Name:HARGROVE, MI KYOUNG (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MI
Middle Name:KYOUNG
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24979 CONSTITUTION AVE APT 1021
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1745
Mailing Address - Country:US
Mailing Address - Phone:562-400-4292
Mailing Address - Fax:
Practice Address - Street 1:24979 CONSTITUTION AVE
Practice Address - Street 2:APT 1021
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381
Practice Address - Country:US
Practice Address - Phone:562-400-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical