Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1588087860 |
---|---|
Provider Name | Tonya Cooper |
First Address | Las Vegas, NV 89108-2969 |
Second Address | Las Vegas, NV 89108-2969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2014 |
Last Update Date | 22/01/2014 |