Individual
MR. ADDISON COOPER
Active
Individual
MR. ADDISON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2012015566
MO
1041C0700X
Clinical Social Worker
Primary
27804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012015566
LICENSE
MO
01
—
27804
LICENSE
CA
Enumeration date
12/20/2012
Last updated
01/27/2017
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