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NPI Code Detail

MEDICARE: BRANDON COOPER

MEDICARE: BRANDON 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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.161916OH

General Provider Information

NPI Number : 1619484516
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON COOPER
Provider Business Mailing Address
First Line : 3304 COLERAIN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45225-1316
Country : US
Telephone Number : 513-241-2965
Fax Number :
Provider Business Practice Location Address
First Line : 1526 REPUBLIC ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7016
Country : US
Telephone Number : 513-241-2965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2018
Last Update Date : 05/11/2026

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Directions to “ BRANDON COOPER ” Practice Location

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