MEDICARE: DR. CHRISTOPHER LEONARD COOPER PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 23144	CA
2	103TF0000X	Family Psychologist	PSY 23144	CA
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY 23144	CA
4	103TP2701X	Group Psychotherapy Psychologist	PSY23144	CA
5	103TC0700X	Clinical Psychologist	PSY 23144	CA

General Provider Information

NPI Number	:	1417008673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER LEONARD COOPER PHD

Provider Business Mailing Address
First Line	:	6809 INDIANA AVE STE 130-A60
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4221
Country	:	US
Telephone Number	:	800-790-0890
Fax Number	:	855-550-4620

Provider Business Practice Location Address
First Line	:	6809 INDIANA AVE STE 130-A60
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4221
Country	:	US
Telephone Number	:	800-790-0890
Fax Number	:	855-550-4620

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	12/14/2018

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