Provider Demographics
NPI:1740176171
Name:COOPER, L C IV
Entity type:Individual
Prefix:MR
First Name:L
Middle Name:C
Last Name:COOPER
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8415
Mailing Address - Country:US
Mailing Address - Phone:501-693-6218
Mailing Address - Fax:
Practice Address - Street 1:1529 HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8415
Practice Address - Country:US
Practice Address - Phone:501-693-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician