Provider Demographics
NPI:1851570428
Name:MACGILLIVRAY, KATHRYN MATHESON (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MATHESON
Last Name:MACGILLIVRAY
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 1:31949 COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6867
Mailing Address - Country:US
Mailing Address - Phone:949-542-2121
Mailing Address - Fax:
Practice Address - Street 1:30101 TOWN CENTER DR
Practice Address - Street 2:109
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5006
Practice Address - Country:US
Practice Address - Phone:949-542-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist