Provider Demographics
NPI:1407093446
Name:COTE, KRISTIN (MA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:COTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHERRY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4395
Mailing Address - Country:US
Mailing Address - Phone:209-239-3334
Mailing Address - Fax:209-465-3416
Practice Address - Street 1:250 CHERRY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4395
Practice Address - Country:US
Practice Address - Phone:209-239-3334
Practice Address - Fax:209-465-3416
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC2971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist