Healthcare Provider Details

I. General information

NPI: 1386710267
Provider Name (Legal Business Name): AMIE LYNN COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MAIN ST
WINDSOR MO
65360-1449
US

IV. Provider business mailing address

327 E AIRPORT DR
CARTHAGE MO
64836-3402
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2182
  • Fax: 660-647-3617
Mailing address:
  • Phone: 417-237-0604
  • Fax: 417-237-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2006035361
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: