Healthcare Provider Details

I. General information

NPI: 1164341913
Provider Name (Legal Business Name): CAROLINE QUEVEDO COUPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27601 FORBES RD STE 49
LAGUNA NIGUEL CA
92677-1242
US

IV. Provider business mailing address

32460 CROWN VALLEY PKWY APT 111
DANA POINT CA
92629-3348
US

V. Phone/Fax

Practice location:
  • Phone: 949-205-7245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT158182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: