Provider Demographics
NPI:1285167445
Name:COOPER, KAYLA JANAY
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JANAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 GREENCREST DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5108
Mailing Address - Country:US
Mailing Address - Phone:504-303-9074
Mailing Address - Fax:
Practice Address - Street 1:236 GREENCREST DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5108
Practice Address - Country:US
Practice Address - Phone:504-303-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health