Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | T-LMLP 2602 | KS |
NPI | 1134515224 |
---|---|
Provider Name | Mr. John Lunsford Cooley |
First Address | Lawrence, KS 66044-1368 |
Second Address | Lawrence, KS 66044-1368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 15/04/2015 |