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General NPI Number Information
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NPI Number | 1053842237
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Entity Type | Individual
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Provider Name | AUDREY COOPER
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Gender | Female
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4530 S DECATUR BLVD STE 201A
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City | LAS VEGAS
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State | NV
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Zip | 89103-5239
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Country | US
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Telephone | 775-309-7672
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Fax |
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Provider Business Mailing Address
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Address Line | 3417 LIVIA AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-7234
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Country | US
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Telephone | 702-902-3738
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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