Individual
CHARLES MARCUS COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
101 MED TECH PKWY, JOHNSON CITY, TN 37604-4007
(423) 232-6120
Mailing address
101 MED TECH PKWY, JOHNSON CITY, TN 37604-4007
(423) 232-6120
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1084
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14722
CARITEN
TN
01
—
186690
ANTHEM (KPT)
TN
01
—
186693
ANTHEM JC
TN
05
—
3584891
—
TN
01
—
4010675
BLUE CROSS (MENTAL HEALTH
TN
01
—
4104023
BLUE CROSS (MEDICAL)
TN
01
—
7241087
AETNA
TN
01
—
TN0107
JOHN DEERE
TN
Enumeration date
06/28/2006
Last updated
07/08/2007
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