Healthcare Provider Details

I. General information

NPI: 1962670331
Provider Name (Legal Business Name): TERENCE E. COOPER C.I.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 WEST SHAMROCK UNIT 6 MEADOW LANE
PINEVILLE LA
71360
US

IV. Provider business mailing address

PO BOX 7118
ALEXANDRIA LA
71306-0118
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6400
  • Fax: 318-487-5703
Mailing address:
  • Phone: 318-484-6400
  • Fax: 318-487-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: