Healthcare Provider Details

I. General information

NPI: 1760307383
Provider Name (Legal Business Name): MARISSA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W LAMBERT RD STE 212
BREA CA
92821-3920
US

IV. Provider business mailing address

31042 VIA LIMON
SAN JUAN CAPISTRANO CA
92675-5538
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-6249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: