Provider Demographics
NPI:1033756911
Name:COOPER-MCNINCH, JULIE MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:COOPER-MCNINCH
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 1:661 GORHAM LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2773
Mailing Address - Country:US
Mailing Address - Phone:269-615-5715
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-005
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5381
Practice Address - Country:US
Practice Address - Phone:269-341-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011051091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical