Provider Demographics
NPI:1194242693
Name:HARVEY-COOPER, KIM LATICE (LPC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:LATICE
Last Name:HARVEY-COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:LATICE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 S MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-2318
Mailing Address - Country:US
Mailing Address - Phone:601-604-1302
Mailing Address - Fax:
Practice Address - Street 1:300 W GEORGE E ALLEN DR # B
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1204
Practice Address - Country:US
Practice Address - Phone:662-728-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional