Provider Demographics
NPI:1528281151
Name:COOPER, KRISTINA SPEER (MFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:SPEER
Last Name:COOPER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 KING ST
Mailing Address - Street 2:#325
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4018
Mailing Address - Country:US
Mailing Address - Phone:650-619-7213
Mailing Address - Fax:
Practice Address - Street 1:220 S CALIFORNIA AVE
Practice Address - Street 2:SUITE # 120
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1641
Practice Address - Country:US
Practice Address - Phone:650-619-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist