Cooper, Charles Marcus

Cooper, Charles Marcus is an individual health care provider with primary practice located at 101 Med Tech Pkwy , Johnson City TN 37604-4007. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Cooper, Charles Marcus can be contacted via phone (423) 232-6120.

Contact Information

Primary practice address
101 Med Tech Pkwy Johnson City TN 37604-4007
Phone: (423) 232-6120
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1084 Tennessee

Profile Details

NPI number 1699703835
LBN Legal business name Cooper, Charles Marcus
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699703835 NPPES
Tennessee MEDICAID 3584891
Tennessee Other 7241087
Tennessee Other 186690
Tennessee Other TN0107
Tennessee Other 14722
Tennessee Other 186693
Tennessee Other 4010675
Tennessee Other 4104023

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