Provider Demographics
NPI:1962129015
Name:DE COSSIO, CHRISTINA (MFT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DE COSSIO
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 1:12735 ALLISON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9606
Mailing Address - Country:US
Mailing Address - Phone:415-606-0040
Mailing Address - Fax:
Practice Address - Street 1:12735 ALLISON RANCH RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9606
Practice Address - Country:US
Practice Address - Phone:415-606-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist