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General NPI Number Information
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NPI Number | 1790180859
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Entity Type | Individual
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Provider Name | MARY KAREN PAPAGOLOS LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 2800 W MARCH LN STE 473
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City | STOCKTON
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State | CA
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Zip | 95219
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Country | US
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Telephone | 619-871-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 430 F ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-3711
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Country | US
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Telephone | 619-420-3620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 101592
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License Number State | CA
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