Provider Demographics
NPI:1477198943
Name:COOPRIDER, BRANDI J (LMHC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:J
Last Name:COOPRIDER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:COOPRIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:3021 ALCAZAR PL APT 204
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2884
Mailing Address - Country:US
Mailing Address - Phone:613-398-0955
Mailing Address - Fax:
Practice Address - Street 1:3577 SW CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8153
Practice Address - Country:US
Practice Address - Phone:772-220-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health