Healthcare Provider Details

I. General information

NPI: 1851578603
Provider Name (Legal Business Name): EVELYN KAGAN PSYD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 WILLIS AVE APT 102
SHERMAN OAKS CA
91403-2654
US

IV. Provider business mailing address

4642 WILLIS AVE APT 102
SHERMAN OAKS CA
91403-2654
US

V. Phone/Fax

Practice location:
  • Phone: 818-395-6144
  • Fax:
Mailing address:
  • Phone: 818-395-6144
  • Fax: 818-878-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT37665
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT37665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: