# KIMBERLY V. FOGARTY, LICENSED MARRIAGE & FAMILY THERAPY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Innerself TeleTherapy, Kim Fogarty, Psychotherapist
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922463660
- **Authorized official:** KIMBERLY VERMILLION FOGARTY JD, LMFT, BC-TMH (OWNER/PSYCHOTHERAPIST)
- **Authorized official phone:** (949) 424-9755

## Contact information

- **Practice address:** 8 PACIFICO, LAGUNA NIGUEL, CA 92677-4242
- **Practice address phone:** (949) 424-9755
- **Practice address fax:** (949) 488-0344
- **Mailing address:** 580 BROADWAY ST STE 208, LAGUNA BEACH, CA 92651-4311
- **Mailing address phone:** (949) 424-9755
- **Mailing address fax:** (949) 488-0344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | LMFT89459 | CA | Yes |

## Other

- **Enumeration date:** 12/23/2015
- **Last updated:** 01/13/2019