Provider Demographics
NPI:1447405212
Name:COOPER-NURSE, JAMES PHILIP (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PHILIP
Last Name:COOPER-NURSE
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GOV CARLOS G CAMACHO RD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3129
Mailing Address - Country:US
Mailing Address - Phone:671-647-1902
Mailing Address - Fax:
Practice Address - Street 1:790 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3129
Practice Address - Country:US
Practice Address - Phone:671-647-1902
Practice Address - Fax:671-647-0250
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60034520101Y00000X, 101YM0800X, 101YP2500X
GULMHC-025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional