Provider Demographics
NPI:1568631190
Name:COOPER, JEANNIE ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:ELIZABETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 W PECAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4350
Mailing Address - Country:US
Mailing Address - Phone:480-540-1620
Mailing Address - Fax:
Practice Address - Street 1:4202 N 32ND ST STE J
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4765
Practice Address - Country:US
Practice Address - Phone:602-381-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional