1477617801 NPI number — DR. DENISE LOUISE KOGER PSY.D., MFT

Table of content: DR. DENISE LOUISE KOGER PSY.D., MFT (NPI 1477617801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477617801 NPI number — DR. DENISE LOUISE KOGER PSY.D., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOGER
Provider First Name:
DENISE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477617801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55422
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91413-0422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-438-3817
Provider Business Mailing Address Fax Number:
818-995-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16550 VENTURA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-438-3817
Provider Business Practice Location Address Fax Number:
818-386-8096
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC33431 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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