Provider Demographics
NPI:1982742375
Name:COOPER, ROBIN KING (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:KING
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CLEVELAND AVE S
Mailing Address - Street 2:SUITE P
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1208
Mailing Address - Country:US
Mailing Address - Phone:651-690-1810
Mailing Address - Fax:651-699-9616
Practice Address - Street 1:241 CLEVELAND AVE S
Practice Address - Street 2:SUITE P
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1208
Practice Address - Country:US
Practice Address - Phone:651-690-1810
Practice Address - Fax:651-699-9616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1212103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59680COOtherBCBS
MN385748400OtherMEDICAL ASSISTANCE
MN680000023Medicare ID - Type UnspecifiedMEDICARE