Individual ProviderEthan R CooperCounselorBehavioral Health & Social Service ProvidersPractice Address2215 Langhorne Rd, Lynchburg, VA 24501-1121(434) 455-3044PECOS EnrollmentThis provider is enrolled in PECOS as ETHAN COOPER.Based on the most recent information from CMS, provider Ethan R Cooper is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1174789119Provider TypeIndividualFull NameCooper, Ethan RCredentialLPCGenderMaleSole ProprietorNoEnumeration Date7/30/2008Last Updated7/30/2008Contact InformationPractice LocationPractice Address2215 Langhorne Rd, Lynchburg, VA 24501-1121Phone(434) 455-3044Fax(434) 948-4918Mailing LocationMailing Address2215 Langhorne Rd, Lynchburg, VA 24501-1121Phone(434) 455-3044Fax(434) 948-4918Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense0701004381VirginiaProvider IdentifiersIDDescriptionIssuerID1871542340DescriptionMedicaidIssuerUnlistedVirginia