MEDICARE: CHELSEY COOPER

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	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1265131940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY COOPER

Provider Business Mailing Address
First Line	:	8606 KINGSLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-0005
Country	:	US
Telephone Number	:	617-817-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	8606 KINGSLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-0005
Country	:	US
Telephone Number	:	617-817-9982
Fax Number	:

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

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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Directions to “ CHELSEY COOPER ” Practice Location

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