Provider Demographics
NPI:1073536587
Name:COOLEY, JUNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:770-417-2733
Mailing Address - Fax:404-373-9423
Practice Address - Street 1:6 CONCOURSE PKWY STE 1650
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5325
Practice Address - Country:US
Practice Address - Phone:770-797-5734
Practice Address - Fax:404-373-9423
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN057065163WP0808X
GAPSY002865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA209210988AMedicaid