Provider Demographics
NPI:1659559102
Name:LOVEGREN, MARY ANN NONE (MFT)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:NONE
Last Name:LOVEGREN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30343 CANWOOD ST STE 208A
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5905
Mailing Address - Country:US
Mailing Address - Phone:805-402-8244
Mailing Address - Fax:
Practice Address - Street 1:30343 CANWOOD ST STE 208A
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5905
Practice Address - Country:US
Practice Address - Phone:805-449-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health