Provider Demographics
NPI:1790180859
Name:PAPAGOLOS, MARY KAREN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAREN
Last Name:PAPAGOLOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:KAREN
Other - Last Name:MAGANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3711
Mailing Address - Country:US
Mailing Address - Phone:619-420-3620
Mailing Address - Fax:
Practice Address - Street 1:2800 W MARCH LN STE 473
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:619-871-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA101592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator