Provider Demographics
NPI:1255622262
Name:COOPER, MATTHEW C (PSYD, MCSP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:COOPER
Suffix:
Gender:M
Credentials:PSYD, MCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 WOODLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6504
Mailing Address - Country:US
Mailing Address - Phone:515-267-1996
Mailing Address - Fax:515-207-9416
Practice Address - Street 1:3408 WOODLAND AVENUE, SUITE 102
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5365
Practice Address - Country:US
Practice Address - Phone:515-267-1996
Practice Address - Fax:515-207-9416
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001265103TC0700X, 103TP0016X
IA000601103TH0100X
IA0003103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service