Active NPI
John D Cooley, PH.D
- Professional Counselor
- Jackson, MO
National Provider Identifier
1992857056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CS001856
- Practice address
- 810 E Jackson Blvd
Suite B1
Jackson, MO 63755-2432 - Phone
- (573) 243-4411
- Fax
- (573) 243-7276
- NPI assigned
- Jan 17, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CS001856 | MO | Primary |
Addresses
Primary practice location
810 E Jackson Blvd
Suite B1
Jackson, MO 63755-2432
Mailing address
810 E Jackson Blvd
Suite B1
Jackson, MO 63755-2432
Phone (573) 243-4411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2055 Craigshire Dr
Suite 417
Saint Louis, MO 63146-4012
Phone (240) 200-0173
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CS001856 | MO | MD | Professional Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1992857056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 E JACKSON BLVD",
"address_2": "SUITE B1",
"city": "JACKSON",
"state": "MO",
"postal_code": "637552432",
"telephone_number": "573-243-4411",
"fax_number": "573-243-7276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 E JACKSON BLVD",
"address_2": "SUITE B1",
"city": "JACKSON",
"state": "MO",
"postal_code": "637552432",
"telephone_number": "573-243-4411",
"fax_number": "573-243-7276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOLEY",
"first_name": "JOHN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "CS001856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.