Provider Demographics
NPI:1619621612
Name:COOPER, ERYNN LEE (ALC)
Entity Type:Individual
Prefix:
First Name:ERYNN
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:ERYNN
Other - Middle Name:FRANCIS
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PERIMETER PARK S STE 100N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3248
Mailing Address - Country:US
Mailing Address - Phone:295-936-2356
Mailing Address - Fax:205-273-5033
Practice Address - Street 1:1 PERIMETER PARK S STE 100N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3248
Practice Address - Country:US
Practice Address - Phone:205-936-2356
Practice Address - Fax:205-273-5033
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC4002A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional