Provider Demographics
NPI:1013031590
Name:COOPER, WILLIAM R (MSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:COOPER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12951 BEL RED RD STE 190
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2698
Mailing Address - Country:US
Mailing Address - Phone:206-517-0036
Mailing Address - Fax:
Practice Address - Street 1:12951 BEL RED RD STE 190
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2698
Practice Address - Country:US
Practice Address - Phone:206-517-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000063821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical