MEDICARE: MRS. ROBYN 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740085125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBYN COOPER

Provider Business Mailing Address
First Line	:	209 N 23RD AVE APT C
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-5920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 JAMESTOWN RD
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-2408
Country	:	US
Telephone Number	:	601-582-6655
Fax Number	:

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

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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Directions to “ MRS. ROBYN COOPER ” Practice Location

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