Provider Demographics
NPI:1821256694
Name:COONEY, LISA (MFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:COONEY
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5591 VOLKERTS RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5937
Mailing Address - Country:US
Mailing Address - Phone:415-307-5922
Mailing Address - Fax:707-823-8490
Practice Address - Street 1:5591 VOLKERTS RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-5937
Practice Address - Country:US
Practice Address - Phone:415-307-5922
Practice Address - Fax:707-823-8490
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist