Provider Demographics
NPI:1043478662
Name:COOPER, ANA GAINEY (LMHC)
Entity type:Individual
Prefix:MS
First Name:ANA
Middle Name:GAINEY
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 142504
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614
Mailing Address - Country:US
Mailing Address - Phone:352-871-6933
Mailing Address - Fax:352-559-0429
Practice Address - Street 1:901 NW 8TH AVENUE, SUITE C-18
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-871-6933
Practice Address - Fax:352-559-0429
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH11073101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004493900Medicaid