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General NPI Number Information
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NPI Number | 1316410640
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Entity Type | Individual
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Provider Name | LIONEL C COOPER MS, PPS, LMFT
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Gender | Male
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 315 MARK WEST SPRINGS ROAD
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-524-2980
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Fax |
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Provider Business Mailing Address
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Address Line | 315 MARK WEST SPRINGS RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-1101
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Country | US
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Telephone | 707-528-2980
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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 | 48148
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License Number State | CA
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