Provider Demographics
NPI:1922140227
Name:COOPER, DONNAU M (MFT)
Entity Type:Individual
Prefix:MS
First Name:DONNAU
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-758-1175
Mailing Address - Fax:714-758-9201
Practice Address - Street 1:415 N STATE COLLEGE BLVD
Practice Address - Street 2:ADP MEDICAL GROUP
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806
Practice Address - Country:US
Practice Address - Phone:714-758-1175
Practice Address - Fax:714-758-9201
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MFC19366Medicare UPIN