Provider Demographics
NPI:1245518695
Name:COOPER, SHERRY (PSYD, LMFT, QS)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PSYD, LMFT, QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34921 US HIGHWAY 19 N STE 204
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1969
Mailing Address - Country:US
Mailing Address - Phone:813-773-6924
Mailing Address - Fax:
Practice Address - Street 1:34921 US HIGHWAY 19 N STE 204
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:813-773-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3803106H00000X
101YM0800X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopath