Provider Demographics
NPI:1215278585
Name:COOPER LOPEZ AND ASSOCIATES
Entity type:Organization
Organization Name:COOPER LOPEZ AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOPER LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:520-369-2511
Mailing Address - Street 1:109 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4406
Mailing Address - Country:US
Mailing Address - Phone:520-369-2511
Mailing Address - Fax:520-413-1250
Practice Address - Street 1:109 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4406
Practice Address - Country:US
Practice Address - Phone:520-369-2511
Practice Address - Fax:520-413-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4353251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health