Provider Demographics
NPI:1104559681
Name:COOPER, HAILEY RENAE (MA)
Entity type:Individual
Prefix:MRS
First Name:HAILEY
Middle Name:RENAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:RENAE
Other - Last Name:BRANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3740 S ISABELLA RD APT 106
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4486
Mailing Address - Country:US
Mailing Address - Phone:785-874-8046
Mailing Address - Fax:
Practice Address - Street 1:724 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1900
Practice Address - Country:US
Practice Address - Phone:989-796-4555
Practice Address - Fax:989-285-1674
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009555103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling