Provider Demographics
NPI:1518524131
Name:BROGGER, ANNIE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:BROGGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:LEIGH
Other - Last Name:CHAPMAN-BROGGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2082 MICHELSON DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1212
Mailing Address - Country:US
Mailing Address - Phone:949-887-7190
Mailing Address - Fax:
Practice Address - Street 1:2082 MICHELSON DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1212
Practice Address - Country:US
Practice Address - Phone:949-887-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist