Provider Demographics
NPI:1396328142
Name:COOPER, FELICIA SHANORA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:SHANORA
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11782 HIGHWAY 518
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-7522
Mailing Address - Country:US
Mailing Address - Phone:318-497-3756
Mailing Address - Fax:
Practice Address - Street 1:11782 HIGHWAY 518
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-7522
Practice Address - Country:US
Practice Address - Phone:318-497-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health