Provider Demographics
NPI:1669759023
Name:COOPER, TARLTON HEATH
Entity type:Individual
Prefix:MS
First Name:TARLTON
Middle Name:HEATH
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HUMMOCK POND RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2660
Mailing Address - Country:US
Mailing Address - Phone:401-451-1482
Mailing Address - Fax:
Practice Address - Street 1:115 HUMMOCK POND RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2660
Practice Address - Country:US
Practice Address - Phone:401-451-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor