Provider Demographics
NPI:1699496695
Name:COOPER, JENNIFER (RMHCI)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COOPER
Suffix:
Gender:
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3404
Mailing Address - Country:US
Mailing Address - Phone:352-391-4510
Mailing Address - Fax:
Practice Address - Street 1:8136 CENTRALIA CT STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3757
Practice Address - Country:US
Practice Address - Phone:352-391-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health