Healthcare Provider Details

I. General information

NPI: 1477585966
Provider Name (Legal Business Name): ALAN FRANCIS COOPER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 FORREST PRESERVE CIRCLE
GAUTIER MS
39553
US

IV. Provider business mailing address

3529 FORREST PRESERVE
GAUTIER MS
39553-5834
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5298
  • Fax: 228-523-4384
Mailing address:
  • Phone: 228-523-5298
  • Fax: 228-523-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: