Healthcare Provider Details

I. General information

NPI: 1255622262
Provider Name (Legal Business Name): MATTHEW C COOPER PSY.D., MCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 WOODLAND AVENUE, SUITE 102
WEST DES MOINES IA
50266-5365
US

IV. Provider business mailing address

3408 WOODLAND AVE STE 102
WEST DES MOINES IA
50266-6504
US

V. Phone/Fax

Practice location:
  • Phone: 515-267-1996
  • Fax: 515-207-9416
Mailing address:
  • Phone: 515-267-1996
  • Fax: 515-207-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001265
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number000601
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number001265
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0003
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: