Provider Demographics
NPI:1417397829
Name:MCGRATH, KIM (MA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4518
Mailing Address - Country:US
Mailing Address - Phone:707-367-1949
Mailing Address - Fax:707-537-8362
Practice Address - Street 1:865 3RD ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4518
Practice Address - Country:US
Practice Address - Phone:707-367-1949
Practice Address - Fax:707-537-8362
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66101YP2500X
CA49776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional