Provider Demographics
NPI:1639104219
Name:COOPER, ROBERT J II (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:COOPER
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 N MAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2933
Mailing Address - Country:US
Mailing Address - Phone:956-378-1463
Mailing Address - Fax:
Practice Address - Street 1:2210 N MAYBERRY RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2933
Practice Address - Country:US
Practice Address - Phone:956-378-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120277781041C0700X
SC111711041C0700X
TX651971041C0700X
KY19351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30608012Medicaid
KY30608012Medicaid