Provider Demographics
NPI:1174671309
Name:COOPER, CASSANDRA SMITH (MED)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:SMITH
Last Name:COOPER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 YVONNE CT
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3151
Mailing Address - Country:US
Mailing Address - Phone:615-855-2219
Mailing Address - Fax:
Practice Address - Street 1:2745 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3041
Practice Address - Country:US
Practice Address - Phone:615-754-5853
Practice Address - Fax:615-754-5826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1604101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional