Basic Information
| Provider Information | |||||||||
| NPI: | 1821294943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIMCHUK-COOK | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 E MAIN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920215204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195905139 | ||||||||
| FaxNumber: | 6195905155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 E MAIN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920215204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195905139 | ||||||||
| FaxNumber: | 6195905155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35875 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.