Healthcare Provider Details

I. General information

NPI: 1831646793
Provider Name (Legal Business Name): MR. TROY COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 YOUREE DR 101
SHREVEPORT LA
71105-2149
US

IV. Provider business mailing address

3341 YOUREE DR 101
SHREVEPORT LA
71105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 319-219-4167
  • Fax:
Mailing address:
  • Phone: 319-219-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: