| Cooper Young Therapist | |
|
832 S Cooper St Memphis TN 38104-5409 | |
| (901) 383-3561 | |
| (901) 791-4390 |
| Full Name | Cooper Young Therapist |
|---|---|
| Speciality | Psychologist |
| Location | 832 S Cooper St, Memphis, Tennessee |
| Authorized Official Name and Position | Earle G Donelson (OWNER) |
| Authorized Official Contact | 9013833561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cooper Young Therapist 832 S Cooper St Memphis TN 38104-5409 Ph: (901) 383-3561 | Cooper Young Therapist 832 S Cooper St Memphis TN 38104-5409 Ph: (901) 383-3561 |
| NPI Number | 1437957669 |
|---|---|
| Provider Enumeration Date | 03/04/2025 |
| Last Update Date | 04/16/2025 |
| Certification Date | 04/16/2025 |
| Medicare PECOS PAC ID | 0840717674 |
|---|---|
| Medicare Enrollment ID | O20250506001297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437957669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Earle Donelson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437212818 PECOS PAC ID: 6901791268 Enrollment ID: I20250506001856 |
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