Provider Demographics
NPI:1295059210
Name:COOPER, RICO (MS)
Entity type:Individual
Prefix:MR
First Name:RICO
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 HIGH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1220
Mailing Address - Country:US
Mailing Address - Phone:850-894-3700
Mailing Address - Fax:
Practice Address - Street 1:2003 APALACHEE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4878
Practice Address - Country:US
Practice Address - Phone:850-894-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health