Provider Demographics
NPI:1982073938
Name:DOUGAN, KATHY-ANN
Entity Type:Individual
Prefix:
First Name:KATHY-ANN
Middle Name:
Last Name:DOUGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13308 MIDLAND RD # 1263
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-7706
Mailing Address - Country:US
Mailing Address - Phone:858-376-9101
Mailing Address - Fax:760-870-5052
Practice Address - Street 1:13308 MIDLAND RD # 1263
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-7706
Practice Address - Country:US
Practice Address - Phone:858-376-9101
Practice Address - Fax:760-870-5052
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist