Individual provider Active NPI

John Lunsford Cooley, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Lubbock, TX
National Provider Identifier
1134515224
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
39946 Issued in TX
Practice address
1901 University Ave RM 103
Lubbock, TX 79410-1544
Phone
(806) 834-5194
NPI assigned
Apr 15, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 39946 TX Primary

Addresses

Primary practice location

1901 University Ave RM 103
Lubbock, TX 79410-1544

Mailing address

Box 42051
Lubbock, TX 79409-2051
Phone (806) 834-5194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240709000918 TX Practitioner - Clinical Psychologist 4486199064 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
39946TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Jun 1, 2024 Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Jun 1, 2024 Accepting new patients

Locations

4000 24th St
#410
Lubbock, TX 79410
Phone (806) 743-7700

4000 24th St
Lubbock, TX 79410
Phone (806) 725-0000

3601 4th St
#1A122
Lubbock, TX 79430
Phone (806) 743-2391

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1134515224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 42051",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794092051",
            "telephone_number": "806-834-5194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 UNIVERSITY AVE RM 103",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101544",
            "telephone_number": "806-834-5194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "JOHN",
        "middle_name": "LUNSFORD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "39946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.