MEDICARE: DR. JUAN ORBERGHETTE COOPER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	78462	TX

General Provider Information

NPI Number	:	1679126767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN ORBERGHETTE COOPER PHD

Provider Business Mailing Address
First Line	:	19202 VALIANT WOODS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3292
Country	:	US
Telephone Number	:	281-384-7746
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N SAM HOUSTON PKWY E STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4070
Country	:	US
Telephone Number	:	281-447-9355
Fax Number	:	713-583-8944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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