Provider Demographics
NPI:1679777866
Name:COOPER, LORAINE A (PHD)
Entity type:Individual
Prefix:DR
First Name:LORAINE
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 STADIUM DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7586
Mailing Address - Country:US
Mailing Address - Phone:813-780-8182
Mailing Address - Fax:
Practice Address - Street 1:6536 STADIUM DR
Practice Address - Street 2:SUITE M
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7586
Practice Address - Country:US
Practice Address - Phone:813-780-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPC129413101YP1600X
FLCPY02400011000103TC0700X
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist