MEDICARE: EARNESTINE COOPER

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1962073304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARNESTINE COOPER

Provider Business Mailing Address
First Line	:	PO BOX 668055
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33066-8055
Country	:	US
Telephone Number	:	954-532-5196
Fax Number	:	954-206-0697

Provider Business Practice Location Address
First Line	:	1951 W COPANS RD STE 8-14
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-1549
Country	:	US
Telephone Number	:	954-532-5196
Fax Number	:	954-206-0697

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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Directions to “ EARNESTINE COOPER ” Practice Location

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