Provider Demographics
NPI:1992205983
Name:COWPER, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:COWPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:AARON
Other - Last Name:COWPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:25 S MONTILLA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6000
Mailing Address - Country:US
Mailing Address - Phone:949-610-9696
Mailing Address - Fax:
Practice Address - Street 1:275 BAKER STREET EAST
Practice Address - Street 2:SUITE A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4566
Practice Address - Country:US
Practice Address - Phone:714-361-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist