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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447864228
- **Authorized official:** GINA MARGARET COOKE AMFT (REHAB-MENTOR TEAM LEAD)
- **Authorized official phone:** (916) 394-9195

## Contact information

- **Practice address:** 7171 BOWLING DR STE 300, SACRAMENTO, CA 95823-2043
- **Practice address phone:** (916) 394-9195
- **Mailing address:** 7171 BOWLING DR STE 300, SACRAMENTO, CA 95823-2043
- **Mailing address phone:** (916) 394-9195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2020
- **Last updated:** 08/31/2020