Provider Demographics
NPI:1053640961
Name:COOPER, EUGENE (LCSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3553
Mailing Address - Country:US
Mailing Address - Phone:913-648-6933
Mailing Address - Fax:
Practice Address - Street 1:8226 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3553
Practice Address - Country:US
Practice Address - Phone:913-648-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7623104100000X
MO20090300901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical