Samantha Jolene Cooper, LMFT

Individual provider Active NPI Marriage & Family Therapist · San Andreas, CA

NPI 1225501844 · NPPES record last updated Jan 7, 2019

Key facts

NPI
1225501844
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
License
104493 (CA)
Practice address
23 West Saint Charles
San Andreas, CA 95249
Phone
(209) 395-0955
NPI assigned
Jan 7, 2019
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
104493CAMDMarriage & Family Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 104493 CA Yes

Addresses

Primary practice location

23 West Saint Charles
San Andreas, CA 95249

Mailing address

PO Box 1443
Valley Springs, CA 95252-1443
Phone (209) 395-0955

Other providers in San Andreas, CA

All providers in San Andreas, CA · Marriage & Family Therapist in California

Sources for this page

Verify at the official NPI Registry.