Provider Demographics
NPI:1215188016
Name:COOPER, BETHANY L
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 RURAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5548
Mailing Address - Country:US
Mailing Address - Phone:620-487-4141
Mailing Address - Fax:620-208-9393
Practice Address - Street 1:1624 RURAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5548
Practice Address - Country:US
Practice Address - Phone:620-487-4141
Practice Address - Fax:620-208-9393
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health