Provider Demographics
NPI:1851935282
Name:COOPRIDE, MARGARET LINNDY (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:LINNDY
Last Name:COOPRIDE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E YELM AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8714
Mailing Address - Country:US
Mailing Address - Phone:360-960-8595
Mailing Address - Fax:
Practice Address - Street 1:715 E YELM AVE STE 6
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8714
Practice Address - Country:US
Practice Address - Phone:360-960-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60539777101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)