Provider Demographics
NPI:1760621239
Name:MENDEZ COOPER, BRENA LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:BRENA
Middle Name:LOUISE
Last Name:MENDEZ COOPER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BRENA
Other - Middle Name:LOUISE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:370 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1727
Mailing Address - Country:US
Mailing Address - Phone:310-787-1500
Mailing Address - Fax:
Practice Address - Street 1:1303 W WALNUT PKWY
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5030
Practice Address - Country:US
Practice Address - Phone:562-745-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77680106H00000X
CALMFT97089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist