Healthcare Provider Details

I. General information

NPI: 1336863695
Provider Name (Legal Business Name): COPE COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N CRAYCROFT RD
TUCSON AZ
85711-1405
US

IV. Provider business mailing address

1477 W COMMERCE CT
TUCSON AZ
85746-6016
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-3293
  • Fax:
Mailing address:
  • Phone: 520-792-3293
  • Fax: 520-792-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RODNEY COOK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 520-792-3293