Provider Demographics
NPI:1780436980
Name:COOPER, SHYENNE KAY (MS, PLMHP)
Entity type:Individual
Prefix:
First Name:SHYENNE
Middle Name:KAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W B ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5139
Mailing Address - Country:US
Mailing Address - Phone:308-660-6281
Mailing Address - Fax:
Practice Address - Street 1:805 W B ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5139
Practice Address - Country:US
Practice Address - Phone:308-660-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health