Provider Demographics
NPI:1437572443
Name:COOPER, HASKELL (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:HASKELL
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632279
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2279
Mailing Address - Country:US
Mailing Address - Phone:936-633-0993
Mailing Address - Fax:936-622-0994
Practice Address - Street 1:412 NORTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5077
Practice Address - Country:US
Practice Address - Phone:936-622-0993
Practice Address - Fax:936-622-0994
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical