Provider Demographics
NPI:1598311417
Name:COOPER, BAYESHAN WANG
Entity Type:Individual
Prefix:
First Name:BAYESHAN
Middle Name:WANG
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NW 85TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4237
Mailing Address - Country:US
Mailing Address - Phone:206-828-4886
Mailing Address - Fax:
Practice Address - Street 1:1405 NW 85TH ST STE 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4237
Practice Address - Country:US
Practice Address - Phone:206-828-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH61363081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health