Provider Demographics
NPI:1194275289
Name:COOPER, GOLDIE LYNN (LMSW,QMHP,QIDP,CMHP)
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW,QMHP,QIDP,CMHP
Other - Prefix:
Other - First Name:GOLDIE
Other - Middle Name:LYNN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3865 S MACKINAC TRL
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-9286
Mailing Address - Country:US
Mailing Address - Phone:906-635-3725
Mailing Address - Fax:906-632-1163
Practice Address - Street 1:3865 S MACKINAC TRL
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-9286
Practice Address - Country:US
Practice Address - Phone:906-635-3725
Practice Address - Fax:906-632-1163
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680211001861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical