Individual
MR. TAZHE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED
Contact information
Practice address
610 WINTON ST, PHILADELPHIA, PA 19148-3240
(267) 340-6717
Mailing address
610 WINTON ST, PHILADELPHIA, PA 19148-3240
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH003390
PA
Other
Enumeration date
10/27/2017
Last updated
10/27/2017
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