Provider Demographics
NPI:1043778525
Name:GROGAN, KATHRYN M (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:M
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:12011 SAN VICENTE BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4946
Mailing Address - Country:US
Mailing Address - Phone:310-600-1195
Mailing Address - Fax:
Practice Address - Street 1:12011 SAN VICENTE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4946
Practice Address - Country:US
Practice Address - Phone:310-600-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist