MEDICARE: GUY CALDERON COOPER MS, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0134851	NM
2	101YP2500X	Professional Counselor	CP0079	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12038643	OTHER	NV	CAQH

General Provider Information

NPI Number	:	1205164290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY CALDERON COOPER MS, LCPC

Provider Business Mailing Address
First Line	:	8228 CHIMNEY BLUFFS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-4412
Country	:	US
Telephone Number	:	702-985-7511
Fax Number	:	702-645-4919

Provider Business Practice Location Address
First Line	:	8228 CHIMNEY BLUFFS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-4412
Country	:	US
Telephone Number	:	702-985-7511
Fax Number	:	702-645-4919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	01/28/2014

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