Healthcare Provider Details

I. General information

NPI: 1023584695
Provider Name (Legal Business Name): RAYLA COOPER PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 12TH ST
NORTH PLATTE NE
69101-2365
US

IV. Provider business mailing address

124 S 24TH ST STE 230
OMAHA NE
68102-1226
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-0587
  • Fax: 308-532-0653
Mailing address:
  • Phone: 402-978-5632
  • Fax: 402-591-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11636
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: