Provider Demographics
NPI:1326768813
Name:COPE, JERRY L
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:COPE
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 1:10710 DEL RUDINI ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4216
Mailing Address - Country:US
Mailing Address - Phone:559-359-3929
Mailing Address - Fax:
Practice Address - Street 1:5625 CAMERON ST STE 5649
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2204
Practice Address - Country:US
Practice Address - Phone:559-359-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst