Provider Demographics
NPI:1073335873
Name:COOKE, KARIN COURTNEY (AMFT)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:COURTNEY
Last Name:COOKE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 TRESTLE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2516
Mailing Address - Country:US
Mailing Address - Phone:510-697-1126
Mailing Address - Fax:
Practice Address - Street 1:400 ESTUDILLO AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4900
Practice Address - Country:US
Practice Address - Phone:510-224-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist