Provider Demographics
NPI:1497175392
Name:COOPER, GARY TAYLOR (BS, CADC-I)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:TAYLOR
Last Name:COOPER
Suffix:
Gender:M
Credentials:BS, CADC-I
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 17818
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-7818
Mailing Address - Country:US
Mailing Address - Phone:503-399-5597
Mailing Address - Fax:503-316-9740
Practice Address - Street 1:3325 HAROLD DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1339
Practice Address - Country:US
Practice Address - Phone:503-399-5597
Practice Address - Fax:503-316-9740
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)