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Individual

MR. GEORGE STEVEN COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 865-1700

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
M6958
MS
104100000X
Social Worker
Primary
C6958
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00018213
MS
Enumeration date
05/16/2012
Last updated
06/11/2021
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