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General NPI Number Information
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NPI Number | 1912485772
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Entity Type | Individual
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Provider Name | CHRISTAL JUNE COOPER LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 823 PARKCENTRE WAY
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City | NAMPA
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State | ID
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Zip | 83651-1783
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Country | US
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Telephone | 208-475-5065
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Fax | 208-463-0972
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Provider Business Mailing Address
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Address Line | 11510 W 1ST ST
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City | STAR
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State | ID
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Zip | 83669-5267
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Country | US
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Telephone | 208-921-9931
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LMSW-28189
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License Number State | ID
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