Healthcare Provider Details

I. General information

NPI: 1265959746
Provider Name (Legal Business Name): KHOURY COOPER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST BLDG 21
HENDERSON NV
89014-8771
US

IV. Provider business mailing address

375 N STEPHANIE ST BLDG 21
HENDERSON NV
89014-8771
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax:
Mailing address:
  • Phone: 702-799-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10968-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: