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NPI Code Detail

MEDICARE: ETHEL COOPER

MEDICARE: ETHEL 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1760740559
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHEL COOPER
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 503-522-6610
Fax Number :
Provider Business Practice Location Address
First Line : 20025 MOSSY MEADOWS AVE
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-7136
Country : US
Telephone Number : 503-496-0207
Fax Number : 503-496-0349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2012
Last Update Date : 02/18/2016

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Directions to “ ETHEL COOPER ” Practice Location

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