Provider Demographics
NPI:1326033473
Name:COOLEY, MYLES L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 N MILITARY TRL
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5984
Mailing Address - Country:US
Mailing Address - Phone:561-694-0001
Mailing Address - Fax:
Practice Address - Street 1:9121 N MILITARY TRL
Practice Address - Street 2:SUITE 218
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5984
Practice Address - Country:US
Practice Address - Phone:561-694-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75127Medicare ID - Type Unspecified