Provider Demographics
NPI:1841405578
Name:COHEN, ELLEN RUTH (PHD MFT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RUTH
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 OYSTER BAY AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-747-0602
Mailing Address - Fax:
Practice Address - Street 1:719 2ND ST
Practice Address - Street 2:SUITE #4
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4666
Practice Address - Country:US
Practice Address - Phone:530-756-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT022121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist