Provider Demographics
NPI:1255451829
Name:COOPER, EARLY B (LMPH, LADC, CPC)
Entity type:Individual
Prefix:MR
First Name:EARLY
Middle Name:B
Last Name:COOPER
Suffix:
Gender:M
Credentials:LMPH, LADC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 CORBY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3320
Mailing Address - Country:US
Mailing Address - Phone:402-451-5462
Mailing Address - Fax:402-451-5462
Practice Address - Street 1:3040 LAKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3700
Practice Address - Country:US
Practice Address - Phone:402-813-2505
Practice Address - Fax:402-451-5462
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health