Provider Demographics
NPI:1588222111
Name:COOPER, RYAN RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RAY
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 NE LOOP 286 STE 200
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5091
Mailing Address - Country:US
Mailing Address - Phone:781-392-7319
Mailing Address - Fax:
Practice Address - Street 1:3605 NE LOOP 286 STE 200
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5091
Practice Address - Country:US
Practice Address - Phone:781-392-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX39279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty