Provider Demographics
NPI:1982093506
Name:JILL M. COOPER
Entity type:Organization
Organization Name:JILL M. COOPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:650-529-5188
Mailing Address - Street 1:1300 UNIVERSITY DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4203
Mailing Address - Country:US
Mailing Address - Phone:650-529-5188
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR
Practice Address - Street 2:SUITE 6
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4203
Practice Address - Country:US
Practice Address - Phone:650-529-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty