Provider Demographics
NPI:1740955798
Name:COOPER, STEPHANIE (RP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3808
Mailing Address - Country:US
Mailing Address - Phone:615-668-4031
Mailing Address - Fax:
Practice Address - Street 1:515 FLEMING ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3808
Practice Address - Country:US
Practice Address - Phone:719-419-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health