Provider Demographics
NPI:1326529603
Name:COOPER, CATHERINE ANN (MA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 230
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4801
Mailing Address - Country:US
Mailing Address - Phone:727-389-9558
Mailing Address - Fax:
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 230
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4801
Practice Address - Country:US
Practice Address - Phone:727-389-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health