Provider Demographics
NPI:1417008673
Name:COOPER, CHRISTOPHER LEONARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEONARD
Last Name:COOPER
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 1:6809 INDIANA AVE STE 130-A60
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4221
Mailing Address - Country:US
Mailing Address - Phone:800-790-0890
Mailing Address - Fax:855-550-4620
Practice Address - Street 1:6809 INDIANA AVE STE 130-A60
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4221
Practice Address - Country:US
Practice Address - Phone:800-790-0890
Practice Address - Fax:855-550-4620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23144103TC2200X, 103TF0000X, 103TM1800X, 103TC0700X
CAPSY23144103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy