Provider Demographics
NPI:1598867566
Name:COOLEY, JOHNNIE SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOHNNIE
Middle Name:SUE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHNNIE
Other - Middle Name:SUE
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:270 CAGNEY LN
Mailing Address - Street 2:#101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2673
Mailing Address - Country:US
Mailing Address - Phone:714-480-6743
Mailing Address - Fax:714-568-4933
Practice Address - Street 1:405 W 5TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4519
Practice Address - Country:US
Practice Address - Phone:714-834-2125
Practice Address - Fax:714-568-4933
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS207971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical