Healthcare Provider Details

I. General information

NPI: 1598620908
Provider Name (Legal Business Name): MARC DOUGLAS COOPER AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 SIERRA COLLEGE BLVD STE 146
ROSEVILLE CA
95661-9419
US

IV. Provider business mailing address

2437 RONALD MCNAIR WAY
SACRAMENTO CA
95834-4039
US

V. Phone/Fax

Practice location:
  • Phone: 209-734-3612
  • Fax:
Mailing address:
  • Phone: 860-798-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT148015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: