MEDICARE: MR. DAVID JOSEPH COOPER MED LPCC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619984044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID JOSEPH COOPER MED LPCC

Provider Business Mailing Address
First Line	:	12608 STATE ROAD
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	OH
Zip	:	44133-3208
Country	:	US
Telephone Number	:	440-230-1960
Fax Number	:	440-230-1965

Provider Business Practice Location Address
First Line	:	12608 STATE ROAD
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	OH
Zip	:	44133-3208
Country	:	US
Telephone Number	:	440-230-1960
Fax Number	:	440-230-1965

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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