Provider Demographics
NPI:1891024592
Name:COOPER BORKENHAGEN, KRISTEN JOY (MFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JOY
Last Name:COOPER BORKENHAGEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:JOY
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1520 PARKMOOR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2420
Mailing Address - Country:US
Mailing Address - Phone:408-591-7054
Mailing Address - Fax:408-241-7788
Practice Address - Street 1:1520 PARKMOOR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2420
Practice Address - Country:US
Practice Address - Phone:408-591-7054
Practice Address - Fax:408-241-7788
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist