Doctor Name: | JAN RIDDLE COOPER |
NPI Number: | 1609002443 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 287 |
Business Practice Address: | 721 W Maple St Rawlins, WY - 823015447 |
Business Phone Number: | 3073247156 |
Business Fax Number: | 3073281651 |
Mailing Address: | 721 W Maple St, P.o. Box 1056 RAWLINS |
State: | WY |
Postal Code: | 823015447 |
Phone Number: | 3073247156 |
Fax Number: | 3073281651 |
NPI Enumeration Date: | 06/08/2009 |
NPI Last Update Date: | 06/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 287 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |