Provider Demographics
NPI:1447655170
Name:PAMELA COOPER LCSW CAC III LLC
Entity type:Organization
Organization Name:PAMELA COOPER LCSW CAC III LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAC III
Authorized Official - Phone:303-269-1191
Mailing Address - Street 1:3570 E 12TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3434
Mailing Address - Country:US
Mailing Address - Phone:303-269-1191
Mailing Address - Fax:303-395-1462
Practice Address - Street 1:3570 E 12TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3434
Practice Address - Country:US
Practice Address - Phone:303-269-1191
Practice Address - Fax:303-395-1462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAMELA COOPER, LCSW, CAC III LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1700940368OtherINDIVIDUAL MEDICARE NPI
CO1700940368OtherINDIVIDUAL MEDICARE NPI