Provider Demographics
NPI:1588872105
Name:COOLEY, CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-341-8555
Mailing Address - Fax:702-242-4429
Practice Address - Street 1:8440 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-341-8555
Practice Address - Fax:702-242-4429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist