Provider Demographics
NPI:1447523378
Name:COOLEY, CYNTHIA KAY (MS, MFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18462 W LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8291
Mailing Address - Country:US
Mailing Address - Phone:360-333-7220
Mailing Address - Fax:
Practice Address - Street 1:1621 FREEWAY DR
Practice Address - Street 2:210
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2477
Practice Address - Country:US
Practice Address - Phone:360-333-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60106637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist