Healthcare Provider Details

I. General information

NPI: 1184551566
Provider Name (Legal Business Name): CAYSEA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LOUISVILLE RD STE 110
BOWLING GREEN KY
42101-1202
US

IV. Provider business mailing address

1238 CHAUMOUNT RD
PARK CITY KY
42160-9391
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-2100
  • Fax: 270-782-2107
Mailing address:
  • Phone: 270-308-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number251525
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: