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General NPI Number Information
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NPI Number | 1043907900
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Entity Type | Individual
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Provider Name | BRYAN COOPER QMHS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 5040 GREENHURST DR
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-1124
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Country | US
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Telephone | 216-702-8542
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Fax |
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Provider Business Mailing Address
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Address Line | 5040 GREENHURST DR
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-1124
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Country | US
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Telephone | 216-702-8542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | RF347418
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License Number State | OH
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