Provider Demographics
NPI:1922345347
Name:COOPER, JOAN SMITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:SMITH
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 DURAN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6972
Mailing Address - Country:US
Mailing Address - Phone:702-558-6480
Mailing Address - Fax:702-564-8424
Practice Address - Street 1:2412 GRAMERCY PARK
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1932
Practice Address - Country:US
Practice Address - Phone:213-407-0764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical