Provider Demographics
NPI:1245915651
Name:GROGAN, JOHN PAUL (LPCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:GROGAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 STARLIT CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1558
Mailing Address - Country:US
Mailing Address - Phone:870-240-5125
Mailing Address - Fax:
Practice Address - Street 1:89 STARLIT CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-1558
Practice Address - Country:US
Practice Address - Phone:870-240-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0087400101YM0800X
CALPCC12632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health