Provider Demographics
NPI:1104247675
Name:COHEN, CHRISTINE R (PHD, LSSP)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ELM DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-1613
Mailing Address - Country:US
Mailing Address - Phone:972-489-7871
Mailing Address - Fax:
Practice Address - Street 1:102 E MOORE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3243
Practice Address - Country:US
Practice Address - Phone:972-489-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3049103TC2200X
TX6165103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool