Provider Demographics
NPI:1851936462
Name:COOPER, KEVIN DONOVAN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DONOVAN
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 1:4901 LITTLE OAK LN APT 246
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3752
Mailing Address - Country:US
Mailing Address - Phone:916-416-4417
Mailing Address - Fax:
Practice Address - Street 1:1820 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3010
Practice Address - Country:US
Practice Address - Phone:916-313-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)