Provider Demographics
NPI:1720216344
Name:COOPER, CHRISTOPHER JOHNATHAN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHNATHAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ROBERTS LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1763
Mailing Address - Country:US
Mailing Address - Phone:541-942-7073
Mailing Address - Fax:
Practice Address - Street 1:315 ROBERTS LN
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1763
Practice Address - Country:US
Practice Address - Phone:541-942-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health