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General NPI Number Information
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NPI Number | 1760262075
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Entity Type | Individual
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Provider Name | CRYSTAL DAWN KOOP
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Gender | Female
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 4221 WILSHIRE BLVD STE 230
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City | LOS ANGELES
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State | CA
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Zip | 90010-3554
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Country | US
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Telephone | 213-441-6780
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Fax |
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Provider Business Mailing Address
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Address Line | 15560 CHATEAU MONTELENA DR
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City | BAKERSFIELD
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State | CA
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Zip | 93314-5341
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Country | US
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Telephone | 661-301-4780
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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 | 136986
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License Number State | CA
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