Provider Demographics
NPI:1922536978
Name:COOPRIDER, ROBERT JAMES
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:COOPRIDER
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:PO BOX 5462
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0462
Mailing Address - Country:US
Mailing Address - Phone:503-505-6445
Mailing Address - Fax:
Practice Address - Street 1:1335 CANNON ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2589
Practice Address - Country:US
Practice Address - Phone:503-505-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health