Provider Demographics
NPI:1023471729
Name:COOPER, CHRISTOPHER VANCE (LPC, MS, NCC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:VANCE
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPC, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1624
Mailing Address - Country:US
Mailing Address - Phone:503-871-0646
Mailing Address - Fax:971-217-9916
Practice Address - Street 1:302 N WATER ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381
Practice Address - Country:US
Practice Address - Phone:503-874-1818
Practice Address - Fax:971-217-9916
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500707637Medicaid