Provider Demographics
NPI:1528071065
Name:COOPER, JOHN F (PSYD, LP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:COOPER
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E TRAVELERS TRL STE 225
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4191
Mailing Address - Country:US
Mailing Address - Phone:952-707-1819
Mailing Address - Fax:952-707-1810
Practice Address - Street 1:200 E TRAVELERS TRL STE 225
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4191
Practice Address - Country:US
Practice Address - Phone:952-707-1819
Practice Address - Fax:952-707-1810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45310COOtherBCBS GROUP PIN
MNOE011COOtherBCBS IND. PIN
MN6100890OtherUBH/MEDICA PIN
MNHP14993OtherHEALTHPARTNERS IND. PIN
MN30347OtherHEALTHPARTNERS GROUP PIN
MN6100890OtherUBH/MEDICA PIN