Provider Demographics
NPI:1326245283
Name:COOKSON, KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:COOKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5925
Mailing Address - Country:US
Mailing Address - Phone:310-470-8904
Mailing Address - Fax:
Practice Address - Street 1:10516 SANTA MONICA BLVD
Practice Address - Street 2:#1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4964
Practice Address - Country:US
Practice Address - Phone:310-446-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist