Provider Demographics
NPI:1831660562
Name:MCDONOUGH, KATHERINE GRACE (AMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:GRACE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:GRACE
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21186 PRAIRIE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3252
Mailing Address - Country:US
Mailing Address - Phone:949-482-1797
Mailing Address - Fax:
Practice Address - Street 1:2601 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3737
Practice Address - Country:US
Practice Address - Phone:949-293-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist