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General NPI Number Information
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NPI Number | 1528106911
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Entity Type | Individual
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Provider Name | MS. COURTNEY LAURA COONEY
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5030 EL CAMINO AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-4650
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Country | US
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Telephone | 916-609-4951
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Fax | 916-609-5160
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Provider Business Mailing Address
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Address Line | 1004 N STOCKTON ST
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City | STOCKTON
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State | CA
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Zip | 95203-2215
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Country | US
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Telephone | 209-915-4739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 51681
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License Number State | CA
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