Provider Demographics
NPI:1124191630
Name:ISAAC COOKSEY, TAMARA JUANA (MFT INTERN 48733)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JUANA
Last Name:ISAAC COOKSEY
Suffix:
Gender:F
Credentials:MFT INTERN 48733
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:J
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT INTERN 48733
Mailing Address - Street 1:6032 ALTOONA CT
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673
Mailing Address - Country:US
Mailing Address - Phone:916-833-7190
Mailing Address - Fax:
Practice Address - Street 1:4545 9TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95673
Practice Address - Country:US
Practice Address - Phone:916-736-0828
Practice Address - Fax:916-736-0395
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist