| Innerself Teletherapy | |
|
8 Pacifico Laguna Niguel CA 92677-4242 | |
| (949) 424-9755 | |
| (949) 488-0344 |
| Full Name | Innerself Teletherapy |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 8 Pacifico, Laguna Niguel, California |
| Authorized Official Name and Position | Kimberly Vermillion Fogarty (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9494249755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innerself Teletherapy 580 Broadway St Ste 208 Laguna Beach CA 92651-4311 Ph: (949) 424-9755 | Innerself Teletherapy 8 Pacifico Laguna Niguel CA 92677-4242 Ph: (949) 424-9755 |
| NPI Number | 1922463660 |
|---|---|
| Provider Enumeration Date | 12/23/2015 |
| Last Update Date | 01/13/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922463660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | LMFT89459 (California) | Primary |
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