Provider Demographics
NPI:1205994845
Name:COOPER, SUSAN BEAM (PHD LMUP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BEAM
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD LMUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 NORMAL BLVD
Mailing Address - Street 2:SUITE 272
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2890
Mailing Address - Country:US
Mailing Address - Phone:402-434-0949
Mailing Address - Fax:402-488-8525
Practice Address - Street 1:4535 NORMAL BLVD
Practice Address - Street 2:SUITE 272
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2890
Practice Address - Country:US
Practice Address - Phone:402-434-0949
Practice Address - Fax:402-488-8525
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1414101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025233500Medicaid