Provider Demographics
NPI:1063577435
Name:COOPER, MAUREEN R (LPCC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 BAYCREST DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-456-7249
Mailing Address - Fax:
Practice Address - Street 1:1469 S MAIN
Practice Address - Street 2:GENTLE SHEPHERD COUNSELING CENTER
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-499-3065
Practice Address - Fax:330-499-2497
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7447117OtherAETNA
OH000000140317OtherANTHEM BC BS