Provider Demographics
NPI:1629676804
Name:COOPER, SUZANNE BETH SCHIMMEL (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BETH SCHIMMEL
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:B
Other - Last Name:SCHIMMEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8158 E 5TH AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6446
Mailing Address - Country:US
Mailing Address - Phone:303-399-0945
Mailing Address - Fax:
Practice Address - Street 1:8158 E 5TH AVE STE 270
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6446
Practice Address - Country:US
Practice Address - Phone:303-399-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical