Organization
COOPER VILLAGE CORPORATION
Active
Parent organization
29A53005
Organization subpart
Yes
Provider details
NPI number
Legal business name
29A53005
Authorized official
TYRENA LANA BOOKER (EXECUTIVE DIRECTOR)
(281) 771-4200
Entity
Organization
Contact information
Practice address
3518 BLUE MEADOW LN, HOUSTON, TX 77039-5720
(281) 771-4200
Mailing address
13202 BRIAR FOREST DR APT 2124, HOUSTON, TX 77077-2444
(281) 771-4200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356705024
—
TX
Enumeration date
05/05/2018
Last updated
05/05/2018
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