Provider Demographics
NPI:1639947203
Name:KATE M GROGAN, MARRIAGE AND FAMILY THERAPY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KATE M GROGAN, MARRIAGE AND FAMILY THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-600-1195
Mailing Address - Street 1:521 S WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4211
Mailing Address - Country:US
Mailing Address - Phone:310-600-1195
Mailing Address - Fax:
Practice Address - Street 1:12011 SAN VICENTE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4946
Practice Address - Country:US
Practice Address - Phone:310-600-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty