Provider Demographics
NPI:1851570428
Name:MACGILLIVRAY, KATHRYN MATHESON (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MATHESON
Last Name:MACGILLIVRAY
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1534
Mailing Address - Country:US
Mailing Address - Phone:949-228-7722
Mailing Address - Fax:
Practice Address - Street 1:413 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1534
Practice Address - Country:US
Practice Address - Phone:949-228-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist