Provider Demographics
NPI:1275695512
Name:COTTON, JEANIE ELIZABETH (LMFT, MS)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:ELIZABETH
Last Name:COTTON
Suffix:
Gender:F
Credentials:LMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N ELLSWORTH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-375-0209
Mailing Address - Fax:650-367-4942
Practice Address - Street 1:15 N ELLSWORTH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-375-0209
Practice Address - Fax:650-367-4942
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist