Provider Demographics
NPI:1194798199
Name:COOPER, RAY OREM
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:OREM
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:OREM
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3234 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3118
Mailing Address - Country:US
Mailing Address - Phone:540-343-3007
Mailing Address - Fax:540-266-9204
Practice Address - Street 1:611 MCDOWELL AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-1225
Practice Address - Country:US
Practice Address - Phone:540-343-3007
Practice Address - Fax:540-527-2900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001524101YP2500X
VA0717000486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist