Healthcare Provider Details

I. General information

NPI: 1972703528
Provider Name (Legal Business Name): KAREN OGDEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN CHILD MFT

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST A207
COSTA MESA CA
92626-5981
US

IV. Provider business mailing address

2900 BRISTOL ST A207
COSTA MESA CA
92626-5981
US

V. Phone/Fax

Practice location:
  • Phone: 949-355-5461
  • Fax: 949-706-9409
Mailing address:
  • Phone: 949-355-5461
  • Fax: 949-706-9409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: