Provider Demographics
NPI:1306256771
Name:COOPER, CHRISTINA (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4502
Mailing Address - Country:US
Mailing Address - Phone:231-340-2263
Mailing Address - Fax:231-773-4577
Practice Address - Street 1:2836 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4502
Practice Address - Country:US
Practice Address - Phone:231-340-2263
Practice Address - Fax:231-773-4577
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096466171M00000X
MI68011050841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801105084OtherLMSW