Provider Demographics
NPI:1205164290
Name:COOPER, GUY CALDERON (MS, LCPC)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:CALDERON
Last Name:COOPER
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8228 CHIMNEY BLUFFS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4412
Mailing Address - Country:US
Mailing Address - Phone:702-985-7511
Mailing Address - Fax:702-645-4919
Practice Address - Street 1:8228 CHIMNEY BLUFFS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4412
Practice Address - Country:US
Practice Address - Phone:702-985-7511
Practice Address - Fax:702-645-4919
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0134851101YP2500X
NVCP0079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205164290Medicaid
NV12038643OtherCAQH