Provider Demographics
NPI:1447507884
Name:COOPER, ALLISON RENAE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 CANTABRIA HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4647
Mailing Address - Country:US
Mailing Address - Phone:520-240-7204
Mailing Address - Fax:
Practice Address - Street 1:983 CANTABRIA HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-4647
Practice Address - Country:US
Practice Address - Phone:520-240-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health