Individual
CHARLES MARCUS COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
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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