Healthcare Provider Details

I. General information

NPI: 1003720111
Provider Name (Legal Business Name): MADISON SARAH COOPER AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12843 LANDALE ST FL 3
STUDIO CITY CA
91604-1352
US

IV. Provider business mailing address

PO BOX 27344
LOS ANGELES CA
90027-0344
US

V. Phone/Fax

Practice location:
  • Phone: 818-533-2319
  • Fax:
Mailing address:
  • Phone: 818-533-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: