Provider Demographics
NPI:1003971235
Name:COHEN, MITCHELL JAY (MFT)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:JAY
Last Name:COHEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41690 ENTERPRISE CIR N
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5616
Mailing Address - Country:US
Mailing Address - Phone:951-296-9919
Mailing Address - Fax:951-296-9919
Practice Address - Street 1:41690 ENTERPRISE CIR N
Practice Address - Street 2:SUITE 209
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5616
Practice Address - Country:US
Practice Address - Phone:951-296-9919
Practice Address - Fax:951-296-9919
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist