Provider Demographics
NPI:1790108777
Name:GUY COOPER PLLC
Entity Type:Organization
Organization Name:GUY COOPER PLLC
Other - Org Name:INFINITY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:CALDERON
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:702-645-4919
Mailing Address - Street 1:8228 CHIMNEY BLUFFS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4412
Mailing Address - Country:US
Mailing Address - Phone:702-645-4919
Mailing Address - Fax:702-645-4919
Practice Address - Street 1:8228 CHIMNEY BLUFFS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4412
Practice Address - Country:US
Practice Address - Phone:702-645-4919
Practice Address - Fax:702-645-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0079251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12038643OtherCAQH
NV1205164290Medicaid