Provider Demographics
NPI:1326392705
Name:COOPER, LARRY TREVOR
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:TREVOR
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 TERMINAL WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3242
Mailing Address - Country:US
Mailing Address - Phone:775-830-7359
Mailing Address - Fax:775-424-2888
Practice Address - Street 1:1280 TERMINAL WAY STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3242
Practice Address - Country:US
Practice Address - Phone:775-830-7359
Practice Address - Fax:775-424-2888
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor