Provider Demographics
NPI:1437957669
Name:COOPER YOUNG THERAPIST
Entity type:Organization
Organization Name:COOPER YOUNG THERAPIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DONELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:901-383-3561
Mailing Address - Street 1:832 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5409
Mailing Address - Country:US
Mailing Address - Phone:901-383-3561
Mailing Address - Fax:901-791-4390
Practice Address - Street 1:832 S COOPER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5409
Practice Address - Country:US
Practice Address - Phone:901-383-3561
Practice Address - Fax:901-791-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty