Provider Demographics
NPI:1124256573
Name:COOPER, LOIS D (EI SERVICE PROVIDER)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:EI SERVICE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1724
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-1724
Mailing Address - Country:US
Mailing Address - Phone:870-562-2376
Mailing Address - Fax:870-562-2376
Practice Address - Street 1:218 S JEFFERSON
Practice Address - Street 2:SUITE 5
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3902
Practice Address - Country:US
Practice Address - Phone:870-562-2376
Practice Address - Fax:870-562-2376
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator