Provider Demographics
NPI:1477585966
Name:COOPER, ALAN FRANCIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:FRANCIS
Last Name:COOPER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 FORREST PRESERVE
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5834
Mailing Address - Country:US
Mailing Address - Phone:228-523-5298
Mailing Address - Fax:228-523-4384
Practice Address - Street 1:3529 FORREST PRESERVE CIRCLE
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-523-5298
Practice Address - Fax:228-523-4384
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0019921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical