Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | FL |
NPI | 1114566304 |
---|---|
Provider Name | Carey Cooper |
First Address | Orlando, FL 32832-5082 |
Second Address | Kissimmee, FL 34741-5774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2020 |
Last Update Date | 05/01/2020 |