Provider Demographics
NPI:1962670331
Name:COOPER, TERENCE E (CIT)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:E
Last Name:COOPER
Suffix:
Gender:M
Credentials:CIT
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 7118
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0118
Mailing Address - Country:US
Mailing Address - Phone:318-484-6400
Mailing Address - Fax:318-487-5703
Practice Address - Street 1:242 WEST SHAMROCK
Practice Address - Street 2:UNIT 6 MEADOW LANE
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6400
Practice Address - Fax:318-487-5703
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)