Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY21348 | CA |
N | 103T00000X | Psychologist | PSY21348 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY21348 | CA |
Y | 103TE1100X | Exercise & Sports Psychologist | PSY21348 | CA |
NPI | 1073798179 |
---|---|
Provider Name | Casey Cooper |
First Address | Mission Viejo, CA 92691-7359 |
Second Address | Mission Viejo, CA 92691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 04/10/2016 |