Provider Demographics
NPI:1528019668
Name:COOPER, LAURIE E (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 WESTGATE CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8053
Mailing Address - Country:US
Mailing Address - Phone:615-221-7075
Mailing Address - Fax:615-221-7079
Practice Address - Street 1:1624 WESTGATE CIR
Practice Address - Street 2:STE 100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8053
Practice Address - Country:US
Practice Address - Phone:615-221-7075
Practice Address - Fax:615-221-7079
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9912P2084P0800X
TN2346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U537Medicare ID - Type Unspecified