Provider Demographics
NPI:1619479979
Name:WOOG, DEBRA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:WOOG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22365 EL TORO RD # 271
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5053
Mailing Address - Country:US
Mailing Address - Phone:949-233-9058
Mailing Address - Fax:949-296-0398
Practice Address - Street 1:23591 EL TORO RD STE 163
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4765
Practice Address - Country:US
Practice Address - Phone:194-923-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist